OPERATIONS
Measuring What Matters: A New Approach to Emergency Department Boarding By John Riggins, Jr. MD, MHA
SAEM PULSE | MAY-JUNE 2026
At a Glance
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• Why this matters now: Emergency department boarding remains a national crisis, but inconsistent definitions and flawed metrics continue to obscure its true impact and hinder effective solutions. • What you’ll learn: A clearer, systems-based approach to defining and measuring boarding, with practical domains that better reflect patient outcomes, workforce strain, and hospital-wide performance. • Who this is for: Emergency department leaders,
administrators, and policymakers seeking more accurate, actionable ways to understand and address boarding.
Introduction
Emergency department (ED) boarding is a widely recognized crisis among health care leaders, researchers, policymakers, and regulators. Despite broad agreement that boarding harms patients, clinicians, and health systems, there is no standardized definition or set of meaningful measurements to describe its true impact. Professional organizations have attempted to standardize definitions for key stakeholders, but challenges
in applying these definitions across domains persist. Although the literature consistently demonstrates adverse outcomes associated with ED boarding, definitions vary widely and measurements remain inconsistent. Without consensus on what constitutes boarding and how to measure it accurately, policy, operational, and research efforts remain fragmented and ineffective.
Current State of ED Boarding Definitions and Measurements
ED boarding has been defined inconsistently across research, operational, and regulatory domains since its recognition. It has been described using different triggers