Hospital overcrowding is a complex problem with many contributing factors and many potential solutions. Nevertheless, overcrowding has been widely recognized as one of the main obstacles to correct and timely hospital care for patients. The COVID-19 pandemic has only accentuated this issue, and it is important to understand the root causes of overcrowding in order to develop strategies for correcting it.

Overcrowding in the emergency department (ED) is a problem that affects patient safety and quality of care. It contributes to delays in diagnosing and treating the sickest patients, and increases morbidity and mortality. It also limits ED capacity and prevents the smooth flow of patients through the ED triage process. Patients who are unable to be admitted or transferred from the ED due to the lack of available inpatient beds experience prolonged boarding times, which leads to frustration and stress for them and their families.

Boarding times can be reduced by implementing several effective interventions in addition to increasing ED staffing. Internal department improvements such as bedside registration, reducing time from arrival to triage, and provider schedule optimization can help reduce boarding. Externally, the smoothing of elective admissions, early morning discharges from inpatient units, and enhanced weekend discharges can significantly decrease ED boarding and improve ER capacity. These are key interventions for managing ED overcrowding and improving patient outcomes. Moreover, the effectiveness of these interventions has been validated through a number of studies.