Structures, Strategies, and Initiatives to Address ED Boarding Challenges-Slides

Slides

Pdf Summary

The document addresses Emergency Department (ED) boarding—when admitted patients wait prolonged periods in the ED for inpatient beds—a critical and widespread challenge impacting patient safety, equity, financial health, and hospital operations. Data from 2025 reveal that over 25% of patients experienced ED boarding exceeding four hours, with some waiting 24 hours, especially during peak months, disproportionately affecting older adults, non-English/Spanish speakers, and Black patients. Boarding is linked to higher mortality, poorer care quality, and negative patient perceptions.

To combat this boarding crisis, hospital medicine leaders outline multi-pronged interventions across the patient care continuum:

1. <strong>Managing Front Door</strong>: Reducing avoidable admissions through better triage algorithms, rapid outpatient follow-up, remote patient monitoring (RPM), home hospital services, and discharge from the ED with resources.

2. <strong>Managing ED Boarders</strong>: Establishing bed management centers, centralized triage, designated hospitalist teams for holding patients, implementing inpatient hallway boarding when units are full, and arrangements for inter-hospital transfers.

3. <strong>Managing Back Door</strong>: Efforts to accelerate discharges via discharge lounges, throughput initiatives, and partnerships with post-acute care (PAC) providers for smoother transitions.

Key programs described include the Acute Care Bridge Clinic (ACBC) that provides rapid post-discharge follow-up—reducing 7- and 30-day readmissions—and a Transition of Care staffing model that coordinates appointments, remote monitoring, and equipment delivery. For inpatient hallway boarding, criteria ensure safety and patient preference, showing shorter hospital length-of-stay and no adverse outcomes compared to standard beds.

Discharge lounges help improve patient flow by housing discharged patients awaiting rides, though challenges include staffing and patient selection. Delays to skilled nursing facility (SNF) transfers increase length of stay; advanced placement programs with SNF collaboration reduce discharge delays.

To maintain quality care for ED boarders akin to inpatient standards, roles like nurse navigators facilitate care coordination, pharmacy workflows optimize medication management, case managers conduct frequent assessments and discharge planning, and comfort kits improve patient experience.

Overall, this comprehensive approach—combining clinical, operational, and transitional strategies—aims to mitigate the systemic ED boarding crisis by ensuring timely admissions, safe discharges, and continuous care coordination.

Keywords

Emergency Department boarding

patient safety

hospital operations

triage algorithms

remote patient monitoring

inpatient hallway boarding

discharge lounges

post-acute care transitions

Acute Care Bridge Clinic

care coordination