ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Emergency department boarding degrades throughput, delays care, and pushes sick patients into chairs, hallways, and waiting rooms never designed for full emergency evaluation. The problem is no longer just crowding; it is hospital-wide operational failure tied to left-without-being-seen rates, patient satisfaction, clinician morale, and lost revenue.
Emergency Department Boarding Crisis
- Nonstandard care spaces: Boarding shifts evaluation and treatment out of standard ED rooms into triage chairs, hallways, and waiting areas, where interviews, exams, imaging flow, and timely treatment all become harder.
- Throughput metric fallout: The visible downstream effects are worse productivity, higher left-without-being-seen rates, and lower patient satisfaction as new ED arrivals compete with admitted boarders for finite staff and beds.
- Clinician morale injury: Boarding erodes clinician satisfaction because nurses and physicians are forced to care for both admitted and undifferentiated ED patients at once, often with a real sense of institutional disrespect.
- Hospital-wide financial tension: A boarded-up ED cannot room and evaluate new patients, creating lost emergency revenue while exposing the uncomfortable tradeoff between ED access and higher-margin elective surgical admissions.
- System-level relief valves: Potential fixes include chest pain and continuity clinics to avoid unnecessary observation stays, plus redistributing boarders to PACU or inpatient hallways. We get into which ideas may actually move the needle in the episode.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- Loke DE, Green KA, Wessling EG, Stulpin ET, Fant AL. Clinicians' Insights on Emergency Department Boarding: An Explanatory Mixed Methods Study Evaluating Patient Care and Clinician Well-Being. Jt Comm J Qual Patient Saf. 2023;49(12):663-670. PMID: 37479591
- Straube S, et al. The Waiting Game: Emergency Department Boarding and its Financial Costs for Patients, Hospitals and Clinicians. Annals of Emergency Medicine. 2022; 80(4): S168 (Link)
Faculty
- 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.
- 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.
