Systemic solutions to emergency department boarding: the hospitalist's perspective on the need for broader alignment and collaboration

Boarding of admitted patients in the emergency department (ED) is increasingly common and frequently discussed as an issue related to ED throughput. However, ED boarding should instead be seen as a symptom of systemic issues relating to hospital capacity and throughput, requiring a multidisciplinary team approach locally, as well as health system-level policy intervention. Hospitalist clinicians frequently care for boarding patients and are experts in clinical care of acutely ill patients and with experience are often experts in quality improvement as well. In this commentary, we call upon hospitalists and emergency medicine (EM) physicians to tackle this problem together, along with healthcare administrators, to look for potential solutions from the local hospital level up to US federal healthcare policy.