Emergency department overcrowding and inpatient boarding: a statewide glimpse in time

Acad Emerg Med. 2011 Dec;18(12):1386-91. doi: 10.1111/j.1553-2712.2011.01209.x.


Objectives: This was a point-prevalence study designed to quantify the magnitude of emergency department (ED) overcrowding and inpatient boarding. Every ED in Michigan was surveyed at a single point in time on a Monday evening. Given the high patient volumes on Monday evenings, the effect on inpatient boarding the next morning was also reviewed.

Methods: All 134 EDs within the state of Michigan were contacted and surveyed on Monday evening, March 16, 2009, over a single hour and again the following morning. Questions included data on annual census, bed number, number of admitted patients within the ED, ambulance diversion, and ED length of stay.

Results: Data were obtained from 109 of the 134 (81%) hospitals on Monday evening and 99 (74%) on Tuesday morning. There was no difference in annual visits or ED size between participating and nonparticipating EDs. Forty-seven percent of EDs were boarding inpatients on Monday evening, compared with 30% on Tuesday morning. The mean estimated boarding times were 3.7 hours (Monday evening) and 7.2 hours (Tuesday morning). Twenty-four percent of respondents met the definition of overcrowded during sampling times. There was a significant relationship between inpatient boarding and ED overcrowding (p < 0.001). Only three EDs were actively diverting ambulances.

Conclusions: In this study on a single Monday evening, 47% of EDs in Michigan were actively boarding inpatients, while 24% were operating beyond capacity. On the following morning (Tuesday), EDs had fewer boarded inpatients than on Monday evening. However, these boarded inpatients remained in the ED for a significantly longer duration.

Publication types

  • Comparative Study

MeSH terms

  • Bed Occupancy / statistics & numerical data*
  • Crowding*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Inpatients / statistics & numerical data*
  • Length of Stay
  • Male
  • Michigan
  • Patient Admission / statistics & numerical data
  • Quality of Health Care
  • Risk Assessment
  • Time Factors