UMMS Affiliation

Department of Emergency Medicine

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Document Type



Emergency Medicine | Health and Medical Administration | Health Services Administration | Health Services Research


Boarding, the practice of holding patients in emergency departments (ED) after a decision has been made to admit them to the hospital, is well known to adversely affect patient care. Multiple investigations have shown that boarding negatively impacts quality and patient safety outcomes including mortality, readmission rate, hospital length of stay, and patient satisfaction. In addition, boarding is known to be a major contributor to overall ED crowding, which also has been demonstrated to have significant negative impact on quality and safety. Multiple operational tactics are known to reduce boarding but, concerningly, adoption of them has been inconsistent. Also concerning, ED boarding appears to be worsening over time, based upon our unpublished year-over-year review of two large national ED operations benchmarking databases, the Emergency Department Benchmarking Alliance and the Academy of Administrators in Academic Emergency Medicine/Association of Academic Chairs of Emergency Medicine.

The constellation of boarding having been known to adversely affect patient care outcomes for over two decades, inconsistent implementation of tactics known to reduce boarding, and evidence that boarding may be worsening over time naturally raises questions of the barriers to improvement. Chief among these questions is why implementation of boarding-reduction tactics has not consistently occurred, despite their clear benefits. In that regard, some experts have postulated that financial drivers may be at play.

To investigate the potential for financial drivers contributing to boarding, we performed a systematic review, pre-registered with PROSPERO (#CRD42016037794).


emergency department, boarding, hospital, patient care, financial drivers

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Copyright: © 2021 Canellas et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See:

DOI of Published Version



Canellas MM, Kotkowski KA, Michael SS, Reznek MA. Financial Implications of Boarding: A Call for Research. West J Emerg Med. 2021 Apr 9;22(3):736-738. doi: 10.5811/westjem.2021.1.49527. PMID: 34125054; PMCID: PMC8203028. Link to article on publisher's site

Journal/Book/Conference Title

The western journal of emergency medicine

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PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.