Creating public reporting frameworks, aligning payment structures and incentives, and broader adoption of inpatient bed managers are among the strategies experts are calling for to reduce emergency department boarding, according to a newly released report from the Agency for Healthcare Research and Quality.
In October, the AHRQ held a summit attended by hospital and health system executives, patients, policymakers and other stakeholders to identify novel opportunities to address overcrowding and boarding in EDs — an issue affecting hospitals across the country. The summit was held in response to a bipartisan letter members of Congress sent to HHS in 2023 urging the agency to develop and implement solutions to the challenge.
The AHRQ published a report detailing key action items and strategies discussed at the summit March 25. Below is an overview of the key strategies participants highlighted during the meeting.
Strategies proven to be effective:
- Surgical smoothing, which refers to scheduling elective surgeries more evenly throughout the week to reduce peaks in bed demand, thus allowing ED patients to be admitted more efficiently.
- Efforts to streamline discharges, such as discharge lounges, planned discharges and ensuring patients are discharged early in the day as often as possible.
- Use of inpatient bed managers to oversee bed assignment, connect behavioral health patients to alternative services and serve as liaisons to engage executive leadership in efforts to minimize boarding.
In addition to hospital-led efforts, several strategies identified at the summit would require broader policy changes, regulatory support or new reimbursement models to gain traction:
- Establish public reporting and standards around ED boarding, including thresholds by hospital size and required reporting on capacity management plans and denied transfer requests.
- Develop real-time regional bed tracking systems to improve inter-hospital transfers, modeled after COVID-era coordination centers.
- Revise payment incentives to reduce boarding, such as tying reimbursement to timely admission or adjusting CMS Conditions of Participation to require action on boarding.
- Support rural hospitals with transfer-back models — where patients receive specialized care at larger hospitals and then return to rural facilities for recovery — along with expanded access to telehealth specialty consults, contingent on broadband, licensing and reimbursement fixes.
- Expand access to appropriate levels of care for behavioral health patients, including crisis stabilization units, and address reimbursement and parity gaps that hinder access to timely, community-based treatment.
Read more about ED boarding here.
