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Staffing Trends Amid Boarding Challenges: A Five-Year Analysis (2019-2023).

Mitchell Blenden1, Rohini Ghosh2, David Chartash1

  • 1Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|April 3, 2026
PubMed
Summary

Emergency Department (ED) boarding hours significantly increased from 2019-2023 without a rise in physician staffing, worsening the boarding burden. Hospitals increased nursing support, but it did not meet rising demands.

Keywords:
boardingcrowdingemergency departmentpatient flowresource allocationstaffingworkload

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Area of Science:

  • Emergency Medicine
  • Healthcare Operations
  • Health Services Research

Background:

  • Emergency Department (ED) boarding, defined as patients occupying ED beds beyond their acute care needs, is a growing challenge.
  • Rising ED boarding impacts patient flow, care quality, and provider well-being.
  • Understanding trends in clinician staffing relative to boarding is crucial for effective management.

Purpose of the Study:

  • To analyze national trends in clinician staffing (attending physicians, PAs/NPs, hospitalists, nurses) in US Emergency Departments (EDs) between 2019 and 2023.
  • To examine the relationship between increasing ED boarding hours and changes in staffing levels.
  • To assess the impact of staffing on the boarding-to-physician hour ratio.

Main Methods:

  • Retrospective cohort study utilizing data from the Association of Academic Chairs of Emergency Medicine (AACEM) and Academy of Administrators in Academic Emergency Medicine (AAAEM) annual benchmarking surveys (academic years 2019-2023).
  • Included primary academic, academic affiliate, and community affiliate EDs.
  • Evaluated trends in boarding hours, attending physician and PA/NP hours, nursing support, and hospitalist care for boarding patients, stratified by hospital classification.

Main Results:

  • Median ED boarding hours increased by 61.1% from 2019 to 2023.
  • Median attending physician hours remained stable, leading to a 55.6% increase in the boarding-to-attending hour ratio.
  • While nursing support for boarding patients increased significantly, hospitalist management did not show a statistically significant increase.

Conclusions:

  • ED boarding hours have substantially increased without a corresponding rise in attending physician staffing, intensifying the workload per physician.
  • Increased nursing and hospitalist coverage, while present, has not adequately addressed the escalating demands of ED boarding.
  • There is a critical need for updated staffing models and system-level interventions to manage the growing operational and clinical challenges of ED boarding.