Boarding of Admitted and Intensive Care Patients in the Emergency Department

Here is my letter to Keith Steffen in 2001. I was put on probation from the OSF-Emergency Room the next day.

The OSF-ER was seeing far too many patients for its size in 2001. I did not think it was safe for patients to wait so long to be admitted to the hospital. Neither does the American College of Emergency Physicians.

Below is a Policy Statement by the American College of Emergency Physicians in 2008.

Boarding of Admitted and Intensive Care Patients in the Emergency Department

Annals of Emergency Medicine - Volume 52, Issue 2 (August 2008)


Optimal utilization of the emergency department (ED) includes the timely evaluation, management, and stabilization of all patients. The ED should not be utilized as an extension of the intensive care and other inpatient units for admitted patients, because this practice adversely affects quality of care and access to care. ED leadership, hospital administrators, EMS directors, community leaders, state and federal officials, hospital regulators and accrediting bodies should work together to resolve this problem. In order for the ED to continue to provide quality patient care and access to that care, the American College of Emergency Physicians (ACEP) believes that:

• Hospitals have the responsibility to provide quality patient care and optimize patient safety by ensuring the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. If such a transfer cannot be promptly effected for whatever reason, the hospital must provide the supplemental nursing manpower necessary to care for these inpatients boarded in the ED.

• In the event that the number of patients needing evaluation or treatment in an ED is equal to or exceeds the ED's treatment space capacity, admitted patients should be promptly distributed to inpatient units regardless of inpatient bed availability.

• Hospitals should have staffing plans in place that can mobilize sufficient health care and support personnel to meet increased patient needs.

• Hospitals should develop appropriate mechanisms to facilitate availability of inpatient beds.

• Emergency physicians should work with their hospital and medical staff to monitor and improve the use of inpatient resources.

• Staffing patterns applicable to other specialized areas/units of the hospital should apply equally to the ED to assure that patients receive a consistent standard of care, appropriate for the acuity of their condition, within the organization.

• Mutual aid agreements should be in place to assist any hospital that is unable to meet the emergency and intensive care needs of its community.

• Hospital diversion should be instituted only when internal resources have been exhausted and other community facilities have resources available to meet the needs of patients presenting to their facilities. EMS systems should develop mechanisms to address patient diversion by health care facilities utilizing the ACEP policy on ambulance diversion.

• Hospital regulatory and accrediting bodies should mandate standards for prompt transfer of admitted patients from the ED to inpatient units and proactive planning for hospital bed availability.


Revised and approved by the ACEP Board of Directors April 2008

Revised and approved by ACEP Board of Directors January 2007

Originally approved by the ACEP Board of Directors October 2000