Intro: Major shift or merit badge: ACEP emergency department accreditation

Andy Little, DO, Drew Kalnow, DO, and Matthew DeLaney, MD, FACEP, FAAEM

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The summary below is from an episode of ERcast: Clinical Perspectives

Emergency department accreditation could reshape staffing, contracts, and bedside workflow far more than another hospital merit badge. ACEP’s proposed three-tier ED accreditation model sets standards for physician coverage, APC oversight, boarding policies, and core resources in language that reaches directly into daily emergency medicine practice.

ACEP ED Accreditation Framework

Three tier accreditation model: ACEP proposes Level 1, 2, and 3 ED accreditation, linking status to staffing, policies, and resources rather than a single generic quality label.
Applications opening timeline: The program moved from task force work to board approval with applications anticipated in fall 2023, signaling a near-term operational issue rather than a distant policy idea.
Workforce pressure backdrop: The push comes amid boarding, rising volumes, expanding residency spots, more APP staffing, and growing private-equity influence on emergency practice.
Value proposition claims: Accreditation is framed as a signal of quality for patients, safer and fairer work conditions for clinicians, and market differentiation for hospitals, a tension we unpack in the episode.

Contracts Policies and Staffing Standards

Physician contracting protections: Across all tiers, the standards reject non-competes, require due process protections, and state emergency physicians should not sign charts for patients they never saw.
Medical staff parity rules: Emergency physicians are expected to hold the same core staff rights as other physicians, including privileges and access to semiannual itemized billing and collection reports.
Universal policy requirements: All tiers require procedural sedation policies consistent with ACEP guidance, kilogram-only pediatric weights, a disaster surge plan, and a boarding policy for primary psychiatric patients.
Level 1 staffing standard: Level 1 requires a board-certified or board-eligible emergency physician onsite 24/7/365, with every patient personally seen by that physician.
Level 2 and 3 supervision: Level 2 keeps 24/7/365 emergency physician presence but allows APC-first evaluation with physician presentation; Level 3 broadens the model, including telehealth emergency physician backup in rural or critical-access settings. We get into the practical staffing implications in the chapter.
Level specific operational rules: Higher tiers add expectations like consultant response in under 1 hour, ownership of post-discharge critical results and incidental findings, and 24/7 ED POCUS availability.

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References:

Shen YC, Chen G, Hsia RY. Community and Hospital Factors Associated With Stroke Center Certification in the United States, 2009 to 2017. JAMA Netw Open. 2019;2(7):e197855. PMID: 31348507
Pasinringi SA, Rivai F, Arifah N, Rezeki SF. The relationship between service quality perceptions and the level of hospital accreditation. Gac Sanit. 2021;35 Suppl 2:S116-S119. PMID: 34929791
https://www.acep.org/administration/ed-accreditation-program/

Faculty

Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.