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.