Risk Factors, Costs, and Impacts of ED Boarding

NCT07532564 | Completed

• 1 other identifier: HP-00112665
• Study Type: observational
• Target: 30,486
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to learn about the risk factors, costs, and operational impacts of emergency department boarding (patients admitted to the hospital but remaining in the emergency department awaiting placement on an inpatient floor) The main questions it aims to answer is:

1. 1.What characteristics of patients make them more likely to experience ED boarding?
2. 2.What is the impact of ED boarding on costs of health care?
3. 3.How do high-boarding environments affect the clinical care of all patients in the emergency department, including those that do not board themselves.

Conditions

Stroke (CVA) or TIA; Diabetes; Asthma (Diagnosis); COPD (Chronic Obstructive Pulmonary Disease); Sepsis; Hypertension; Heart Failure; Pneumonia; Urinary Tract Infection (Diagnosis); Chest Pain; Psychiatric Disorder; Sickle Cell Disease (SCD)

Keywords

emergency department boarding; health care costs; emergency department operations; health services research

Outcome Measures

Primary Outcomes (1)

• Boarding time

  Time between admission order placement and ED departure. Only patients admitted to services that routinely take primary care responsibility for boarding patients in the ED will be classified as boarders

  During hospitalization encounter

Secondary Outcomes (4)

• Boarding Percentage

  During hospital encounter

• Direct variable cost

  During hospitalization

• Hospital length of stay

  During hospitalization

• Boarding Density Ratio

  During patient's ED stay

Study Arms (1)

Patients Hospitalized from the ED to Boarding Services

Adult patients admitted to floor level services that directly manage patients in the ED (medicine, family medicine, neurology)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients admitted to the hospital under inpatient or observation status from the adult emergency department at an academic medical center, to floor/telemetry inpatient services that directly managed boarded patients in the ED (medicine, family medicine, neurology)

You may qualify if:

• adults presenting to UMMS system hospitals and getting hospitalized by inpatient or observation over study period (2022-2025). At UMMC, should be admitted to an internal medicine team Med 1-4, Med 6, Med 5, med/surg/tele level (no IMC/ICU) and neuro floor level.

You may not qualify if:

• Patients admitted to cardiology, cancer center, surgical services, IMC/ICU

Sponsors & Collaborators

• University of Maryland, Baltimore: lead

Study Sites (1)

University of Maryland Medical Center

Baltimore, Maryland, 21201, United States

Location

Related Publications (18)

• Ren A, Golden B, Alt F, Wasil E, Bjarnadottir M, Hirshon JM, Pimentel L. Impact of Global Budget Revenue Policy on Emergency Department Efficiency in the State of Maryland. West J Emerg Med. 2019 Oct 14;20(6):885-892. doi: 10.5811/westjem.2019.8.43201.

  PMID: 31738715 BACKGROUND

• Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018 Aug 30;13(8):e0203316. doi: 10.1371/journal.pone.0203316. eCollection 2018.

  PMID: 30161242 BACKGROUND

• Bernstein SL, Verghese V, Leung W, Lunney AT, Perez I. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med. 2003 Sep;10(9):938-42. doi: 10.1111/j.1553-2712.2003.tb00647.x.

  PMID: 12957975 BACKGROUND

• Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004 Jan;11(1):38-50. doi: 10.1197/j.aem.2003.07.017.

  PMID: 14709427 BACKGROUND

• Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, Straus HE, Joseph G, Rydman RJ. Distribution of variable vs fixed costs of hospital care. JAMA. 1999 Feb 17;281(7):644-9. doi: 10.1001/jama.281.7.644.

  PMID: 10029127 BACKGROUND

• Schreyer KE, Martin R. The Economics of an Admissions Holding Unit. West J Emerg Med. 2017 Jun;18(4):553-558. doi: 10.5811/westjem.2017.4.32740. Epub 2017 May 1.

  PMID: 28611873 BACKGROUND

• Canellas MM, Jewell M, Edwards JL, Olivier D, Jun-O'Connell AH, Reznek MA. Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing. Ann Emerg Med. 2024 Oct;84(4):376-385. doi: 10.1016/j.annemergmed.2024.04.012. Epub 2024 May 24.

  PMID: 38795079 BACKGROUND

• 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. No abstract available.

  PMID: 34125054 BACKGROUND

• Mitka M. Economics may play role in crowding, boarding in emergency departments. JAMA. 2008 Dec 17;300(23):2714-5. doi: 10.1001/jama.2008.753. No abstract available.

  PMID: 19088342 BACKGROUND

• Stryckman B, Kuhn D, Gingold DB, Fischer KR, Gatz JD, Schenkel SM, Browne BJ. Balancing Efficiency and Access: Discouraging Emergency Department Boarding in a Global Budget System. West J Emerg Med. 2021 Sep 2;22(5):1196-1201. doi: 10.5811/westjem.2021.5.51889.

  PMID: 34546898 BACKGROUND

• Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, McCreath H, Asch SM. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2013 Jun;61(6):605-611.e6. doi: 10.1016/j.annemergmed.2012.10.026. Epub 2012 Dec 6.

  PMID: 23218508 BACKGROUND

• Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Cham Sante S, Shofer FS, Goyal M, Pines JM. The impact of ED crowding on early interventions and mortality in patients with severe sepsis. Am J Emerg Med. 2017 Jul;35(7):953-960. doi: 10.1016/j.ajem.2017.01.061. Epub 2017 Jan 31.

  PMID: 28233644 BACKGROUND

• Lauque D, Khalemsky A, Boudi Z, Ostlundh L, Xu C, Alsabri M, Onyeji C, Cellini J, Intas G, Soni KD, Junhasavasdikul D, Cabello JJT, Rathlev NK, Liu SW, Camargo CA Jr, Slagman A, Christ M, Singer AJ, Houze-Cerfon CH, Aburawi EH, Tazarourte K, Kurland L, Levy PD, Paxton JH, Tsilimingras D, Kumar VA, Schwartz DG, Lang E, Bates DW, Savioli G, Grossman SA, Bellou A. Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. J Clin Med. 2022 Dec 21;12(1):32. doi: 10.3390/jcm12010032.

  PMID: 36614835 BACKGROUND

• Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011 Dec;18(12):1324-9. doi: 10.1111/j.1553-2712.2011.01236.x.

  PMID: 22168198 BACKGROUND

• Boudi Z, Lauque D, Alsabri M, Ostlundh L, Oneyji C, Khalemsky A, Lojo Rial C, W Liu S, A Camargo C Jr, Aburawi E, Moeckel M, Slagman A, Christ M, Singer A, Tazarourte K, Rathlev NK, A Grossman S, Bellou A. Association between boarding in the emergency department and in-hospital mortality: A systematic review. PLoS One. 2020 Apr 15;15(4):e0231253. doi: 10.1371/journal.pone.0231253. eCollection 2020.

  PMID: 32294111 BACKGROUND

• Darraj A, Hudays A, Hazazi A, Hobani A, Alghamdi A. The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review. Healthcare (Basel). 2023 Jan 29;11(3):385. doi: 10.3390/healthcare11030385.

  PMID: 36766963 BACKGROUND

• Kelen GD, Wolfe R, D'onofrio G, et al. Emergency Department Crowding: The Canary in the Health Care System. Published online 2021. doi:10.1056/CAT.21.0217

  BACKGROUND

• Janke AT, Burke LG, Haimovich A. Hospital 'Boarding' Of Patients In The Emergency Department Increasingly Common, 2017-24. Health Aff (Millwood). 2025 Jun;44(6):739-744. doi: 10.1377/hlthaff.2024.01513.

  PMID: 40456033 BACKGROUND

MeSH Terms

Conditions

Stroke; Diabetes Mellitus; Asthma; Disease; Pulmonary Disease, Chronic Obstructive; Sepsis; Hypertension; Heart Failure; Pneumonia; Urinary Tract Infections; Chest Pain; Mental Disorders; Anemia, Sickle Cell

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Chronic Disease; Disease Attributes; Infections; Systemic Inflammatory Response Syndrome; Inflammation; Heart Diseases; Respiratory Tract Infections; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Anemia, Hemolytic, Congenital; Anemia, Hemolytic; Anemia; Hematologic Diseases; Hemic and Lymphatic Diseases; Hemoglobinopathies; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: April 9, 2026
• First Posted: April 16, 2026
• Study Start: January 1, 2022
• Primary Completion: December 31, 2025
• Study Completion: December 31, 2025
• Last Updated: April 16, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)