Emergency Department Boarding and Crowding

Boarding in the ED

“Boarding” in the emergency department is a result of dangerous health system overload that puts patients in a holding pattern as they wait for an inpatient bed or transfer after their initial care. These delays can last hours, days, weeks, or longer.

Boarding is a public health emergency and systemic crisis. Staffing challenges and burnout exacerbate the crisis and perpetuate a dangerous and sometimes deadly cycle. ACEP is taking the lead to identify collaborative solutions.

ACEP Summit on Boarding

ACEP organized and led the first national stakeholder summit on boarding in September 2023. Stakeholders across health care met in the ACEP DC office for a day-long discussion on the dangers of boarding and collaborative opportunities for solutions.

Read the full report on the summit

ED Boarding: Frontline Stories

ACEP members are sharing stories about the impact of rising patient boarding, and the picture painted is bleak—emergency departments and hospitals are at a breaking point.

Read Their Stories Share Your Story


ACEP has been leading national efforts to address ED crowding and boarding for several decades. Currently we are advocating directly with the White House, bipartisan members of Congress, regulatory agencies, and other stakeholders involved in constructive approaches to alleviate the factors that lead to our nation’s boarding crisis.

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Boarding and Crowding Talking Points

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Letter to the White House (November 7, 2022)

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Regs & Eggs: Update on the ED Boarding Crisis

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Pushing for Solutions to the Boarding Crisis

Brewing for years, the boarding crisis hit troublesome levels in late 2022. Your stories, filled with urgency and passion, allowed ACEP to launch a multichannel advocacy campaign.

Tackling the boarding crisis is one of the ways ACEP has your back.

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  1. To Reduce Emergency Department Boarding and Hospital Crowding, Look Beyond the ED (ACEP Now, November 13, 2016)
  2. Tips for Managing Heavy Workloads in the Emergency Department (ACEP Now, September 29, 2017)
  3. Early Hospital Discharge Can Improve Capacity, Patient Flow (ACEP Now, December 11, 2016)
  4. Patient flow through the emergency department (R3 Report | Requirement, Rationale, Reference, The Joint Commission, Issue 4, December 19, 2012)
  5. Association between boarding in the emergency department and in-hospital mortality: a systematic review (PLOS One, April 15, 2020
  6. Emergency Department Crowding: The Canary in the Health Care System (NEJM Catalyst, September 28, 2021)
  7. Boarding Critically Ill Patients in the ED (Journal of the American College of Emergency Physicians Open, July 17, 2020 | DOI:
  8. Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020, DOI:  
  9. US Performance on ED Throughput (2006-2016) (Annals of Emergency Medicine, April 14, 2021  DOI:
  10. Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders (Annals of Emergency Medicine, July 08, 2020 DOI:
  11. The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Boarding and And Crowding (Annals of Emergency Medicine, January 23, 2020 DOI:
  12. High Impact Solutions Report (American College of Emergency Physicians, Emergency Medicine Practice Committee, May 2016)
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