Emergency Department Patient Boarding and Overcrowding
This paper examines the problem of patient boarding in emergency departments (EDs), a major driver of nationwide ED overcrowding that threatens patient safety, increases mortality risk, and diminishes care quality. The paper reviews research linking ED crowding to poor patient outcomes, communication failures during handoffs, ambulance diversions, and rising dissatisfaction. It also outlines practical, evidence-based solutions — including dedicated admission nurses, bed-tracking technology, hospitalist and intensivist programs, and structured census management meetings — that hospitals can implement to improve patient flow, reduce length of stay, and ensure timely access to care.
- Introduction: The ED Boarding Crisis: Boarding admitted patients worsens ED overcrowding nationwide
- Patient Safety Risks and Clinical Outcomes: Overcrowding linked to mortality, liability, and delayed care
- Communication Failures and Handoff Dangers: Poor handoffs drive medical errors and boarding risks
- Ambulance Diversions and Access Limitations: Overcrowding forces ambulance diversions and limits access
- Strategies for Reducing ED Overcrowding: Staffing, technology, and process solutions to reduce boarding
- Conclusion: Efficient patient flow essential to ED safety and access
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- Grounds its argument in multiple cited studies, giving empirical weight to claims about boarding's harm to patient safety and outcomes.
- Moves logically from problem identification (overcrowding, safety risks, communication failures) to concrete, actionable solutions (bed-tracking technology, admission nurses, twice-daily census meetings).
- Draws on authoritative sources including the Joint Commission and ACGME, lending institutional credibility to the policy recommendations.
Key academic technique demonstrated
The paper demonstrates effective problem-solution structure in healthcare policy writing. It systematically builds a case for the severity of ED boarding using research evidence, then transitions to operational recommendations. This technique — establishing harm before proposing remedy — is common and effective in health policy and public health essays.
Structure breakdown
The paper opens with a broad statement of the crisis, then narrows to specific harms: safety risks, supervision gaps, communication failures, and access limitations. The second half pivots to solutions, addressing staffing, technology, and administrative processes in sequence. A brief conclusion ties access to care back to the core public health concern. References follow APA-adjacent formatting with Vancouver-style author listings.
Introduction: The ED Boarding Crisis
Emergency department (ED) crowding is a nationwide crisis that affects the efficiency and quality of patient care (Sox, Burstin, Orav, et al., 2007). A major contributor to patient overcrowding is the boarding of admitted patients in the ED. Time that could be used to treat patients who are waiting to be seen is instead consumed by the admitting process — a pattern typical of overcrowded EDs. The overcrowding of EDs risks patient safety, and alternatives to this practice must be examined.
Holding admitted patients in EDs has long been recognized as harmful to patient flow, but a growing body of research now shows that it also directly harms patients. There is significant evidence demonstrating that ED crowding caused by boarding is responsible for poor patient outcomes (Sox, Burstin, Orav, et al., 2007). In many hospitals, it is the physicians and nurses who care for these boarders in the ED; therefore, any risk taken falls squarely on their shoulders. This not only decreases efficiency but can also give rise to lawsuits ("Lawsuits may arise," 2008).
References
Lawsuits may arise from ED 'boarding' practice: there's proof it harms patients… Part 1 of a two-part series. (2008). ED Legal Letter, 19(12), 136–141.
Take the lead in helping to remedy ED crowding, diversion, boarding: efficient patient throughput is the key. (2006). Hospital Case Management, 14(9), 129–131.
Garson C, Hollander JE, Rhodes KV, et al. (2007). Emergency department patient preferences for boarding locations when hospitals are at full capacity. Ann Emerg Med.
Greene J. (2007). Emergency department flow and the boarded patient: how to get admitted patients upstairs. Ann Emerg Med. 49, 68–70.
Holliman CJ, Wuerz RC, Kimak MJ, et al. (1995). Attending supervision of nonemergency medicine residents in a university hospital ED. Am J Emerg Med. 13, 259–261.
Richardson DB. (2006). Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 184, 213–216.
Sox CM, Burstin HR, Orav EJ, et al. (1998). The effect of supervision of residents on quality of care in five university-affiliated emergency departments. Acad Med. 73, 776–782.
Create your account
Always verify citation format against your institution’s current style guide requirements.