Workforce impact of emergency department boarding

Abstract

Introduction: Emergency department (ED) boarding, or holding admitted patients in the ED due to a lack of available inpatient beds, presents a major challenge to healthcare systems. This study examines the impacts of ED boarding on clinician wellness, burnout, moral injury, and workplace violence. Methods: We distributed a survey to members of the American Academy of Emergency Medicine over 4 weeks in early 2025. It included 9 questions on experiences with boarding, demographics, and practice setting, plus an optional free-response question. Descriptive statistics were performed, and free-response questions were explored for insight and broader themes. Results: Among 195 respondents, 54.1% reported experiencing violence related to ED boarding, and 98.5% reported an impact on job satisfaction. Ninety-six respondents submitted free-text comments, which reflected 4 major themes: frustration and burnout; verbal and physical abuse; moral injury tied to profit-driven decision-making; and impacts on clinical care and patient outcomes. Conclusion: These preliminary findings that highlight additional adverse outcomes of boarding can be used to inform future policy decisions and clinical operations interventions to reduce and mitigate effects of ED boarding.