Emergency department (ED) boarding (EDB) is the practice of holding admitted patients in the ED due to a lack of hospital beds. We identified one ED in our health system with a high rate of EDB. We sought to identify factors associated with EDB in this hospital by comparing it to a similar hospital in our health care system.

Methods: We conducted a retrospective study comparing two community hospitals in our healthcare system. Boarding was defined as a patient waiting ≥8 hours in ED for disposition. One hospital, located in a rural area with 55beds was chosen as it was identified by the healthcare system as having a much higher percentage of boarders, particularly older adults. Another hospital, located in an urban setting and with 275 beds, was chosen for comparison due to a similarity in age demographics. Both hospitals have geriatric ED accreditation. Deidentified, aggregate data was obtained. Acuity of patient illness was calculated on a scale of 1-5, lower scores indicate higher complexity.

Results: The total number of patients seen in the rural ED was 21,167; 33% were ≥65 years; 98% were white. In the urban ED, 23,814 patients were seen; 27% were ≥65 years; 96% were white. The rural ED had a slightly higher (lower complexity) mean acuity score (2.83) compared to the urban ED (2.62). Overall, the rural ED had a proportionately higher number of boarders compared to urban ED (8% vs 2% of all patients). Of these boarders, a much higher percentage were older compared to the urban ED (65% vs 39%).

Conclusion: When compared with the urban ED, the rural ED had a larger proportion of boarders, particularly older adults. EDB does not appear to be related to patient characteristics but may instead be influenced by system and community factors like number of inpatient and nursing home beds. In the future we plan to work with leadership to further determine these factors.




August 8th, 2023


January 15th, 2024


January 31st, 2024


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.