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The goal of this observational study is to learn about the risk factors, costs, and operational impacts of emergency department boarding (patients admitted to the hospital but remaining in the emergency department awaiting placement on an inpatient floor)
The main questions it aims to answer is:
Data will be secondary in nature, collected in the regular Participants already taking intervention A as part of their regular medical care for RA will answer online survey questions about their joint pain for 5 years.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients Hospitalized from the ED to Boarding Services | Adult patients admitted to floor level services that directly manage patients in the ED (medicine, family medicine, neurology) |
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| Measure | Description | Time Frame |
|---|---|---|
| Boarding Time | Time between admission order placement and ED departure. Only patients admitted to services that routinely take primary care responsibility for boarding patients in the ED will be classified as boarders | During enrollment hospital encounter, up to 300 days |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients admitted to the hospital under inpatient or observation status from the adult emergency department at an academic medical center, to floor/telemetry inpatient services that directly managed boarded patients in the ED (medicine, family medicine, neurology)
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Maryland Medical Center | Baltimore | Maryland | 21201 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31738715 | Background | Ren A, Golden B, Alt F, Wasil E, Bjarnadottir M, Hirshon JM, Pimentel L. Impact of Global Budget Revenue Policy on Emergency Department Efficiency in the State of Maryland. West J Emerg Med. 2019 Oct 14;20(6):885-892. doi: 10.5811/westjem.2019.8.43201. | |
| 30161242 | Background | Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018 Aug 30;13(8):e0203316. doi: 10.1371/journal.pone.0203316. eCollection 2018. |
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Risk of violating HIPAA and patient privacy without patient consent.
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| ID | Title | Description |
|---|---|---|
| FG000 | Patients Hospitalized From the ED to Boarding Services | Adult patients admitted to floor level services that directly manage patients in the ED (medicine, family medicine, neurology) |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Apr 8, 2026 | May 20, 2026 |
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| 12957975 | Background | Bernstein SL, Verghese V, Leung W, Lunney AT, Perez I. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med. 2003 Sep;10(9):938-42. doi: 10.1111/j.1553-2712.2003.tb00647.x. |
| 14709427 | Background | Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004 Jan;11(1):38-50. doi: 10.1197/j.aem.2003.07.017. |
| 10029127 | Background | Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, Straus HE, Joseph G, Rydman RJ. Distribution of variable vs fixed costs of hospital care. JAMA. 1999 Feb 17;281(7):644-9. doi: 10.1001/jama.281.7.644. |
| 28611873 | Background | Schreyer KE, Martin R. The Economics of an Admissions Holding Unit. West J Emerg Med. 2017 Jun;18(4):553-558. doi: 10.5811/westjem.2017.4.32740. Epub 2017 May 1. |
| 38795079 | Background | Canellas MM, Jewell M, Edwards JL, Olivier D, Jun-O'Connell AH, Reznek MA. Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing. Ann Emerg Med. 2024 Oct;84(4):376-385. doi: 10.1016/j.annemergmed.2024.04.012. Epub 2024 May 24. |
| 34125054 | Background | Canellas MM, Kotkowski KA, Michael SS, Reznek MA. Financial Implications of Boarding: A Call for Research. West J Emerg Med. 2021 Apr 9;22(3):736-738. doi: 10.5811/westjem.2021.1.49527. No abstract available. |
| 19088342 | Background | Mitka M. Economics may play role in crowding, boarding in emergency departments. JAMA. 2008 Dec 17;300(23):2714-5. doi: 10.1001/jama.2008.753. No abstract available. |
| 34546898 | Background | Stryckman B, Kuhn D, Gingold DB, Fischer KR, Gatz JD, Schenkel SM, Browne BJ. Balancing Efficiency and Access: Discouraging Emergency Department Boarding in a Global Budget System. West J Emerg Med. 2021 Sep 2;22(5):1196-1201. doi: 10.5811/westjem.2021.5.51889. |
| 23218508 | Background | Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, McCreath H, Asch SM. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2013 Jun;61(6):605-611.e6. doi: 10.1016/j.annemergmed.2012.10.026. Epub 2012 Dec 6. |
| 28233644 | Background | Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Cham Sante S, Shofer FS, Goyal M, Pines JM. The impact of ED crowding on early interventions and mortality in patients with severe sepsis. Am J Emerg Med. 2017 Jul;35(7):953-960. doi: 10.1016/j.ajem.2017.01.061. Epub 2017 Jan 31. |
| 36614835 | Background | Lauque D, Khalemsky A, Boudi Z, Ostlundh L, Xu C, Alsabri M, Onyeji C, Cellini J, Intas G, Soni KD, Junhasavasdikul D, Cabello JJT, Rathlev NK, Liu SW, Camargo CA Jr, Slagman A, Christ M, Singer AJ, Houze-Cerfon CH, Aburawi EH, Tazarourte K, Kurland L, Levy PD, Paxton JH, Tsilimingras D, Kumar VA, Schwartz DG, Lang E, Bates DW, Savioli G, Grossman SA, Bellou A. Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. J Clin Med. 2022 Dec 21;12(1):32. doi: 10.3390/jcm12010032. |
| 22168198 | Background | Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011 Dec;18(12):1324-9. doi: 10.1111/j.1553-2712.2011.01236.x. |
| 32294111 | Background | Boudi Z, Lauque D, Alsabri M, Ostlundh L, Oneyji C, Khalemsky A, Lojo Rial C, W Liu S, A Camargo C Jr, Aburawi E, Moeckel M, Slagman A, Christ M, Singer A, Tazarourte K, Rathlev NK, A Grossman S, Bellou A. Association between boarding in the emergency department and in-hospital mortality: A systematic review. PLoS One. 2020 Apr 15;15(4):e0231253. doi: 10.1371/journal.pone.0231253. eCollection 2020. |
| 36766963 | Background | Darraj A, Hudays A, Hazazi A, Hobani A, Alghamdi A. The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review. Healthcare (Basel). 2023 Jan 29;11(3):385. doi: 10.3390/healthcare11030385. |
| Background | Kelen GD, Wolfe R, D'onofrio G, et al. Emergency Department Crowding: The Canary in the Health Care System. Published online 2021. doi:10.1056/CAT.21.0217 |
| 40456033 | Background | Janke AT, Burke LG, Haimovich A. Hospital 'Boarding' Of Patients In The Emergency Department Increasingly Common, 2017-24. Health Aff (Millwood). 2025 Jun;44(6):739-744. doi: 10.1377/hlthaff.2024.01513. |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Patients Hospitalized From the ED to Boarding Services | Adult patients admitted to floor level services that directly manage patients in the ED (medicine, family medicine, neurology) |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Age, continuous, in years | Median | Inter-Quartile Range | years |
| |||||||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| |||||||||||||||||||||||
| Race/Ethnicity, Customized | Self-identified race in the electronic health record | Count of Participants | Participants |
| ||||||||||||||||||||||
| Region of Enrollment | Number | Participants |
| |||||||||||||||||||||||
| Commercial Payor | Commercial Insurance payor | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Boarding Time | Time between admission order placement and ED departure. Only patients admitted to services that routinely take primary care responsibility for boarding patients in the ED will be classified as boarders | Posted | Mean | Standard Deviation | Hours | During enrollment hospital encounter, up to 300 days |
|
|
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from enrollment, up to 365 days
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Patients Hospitalized From the ED to Boarding Services | Adult patients admitted to floor level services that directly manage patients in the ED (medicine, family medicine, neurology) | 0 | 18,526 | 0 | 18,526 | 0 | 18,526 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Daniel Gingold, Principal Investigator | University of Maryland School of Medicine, Department of Emergency Medicine | 667-214-2177 | dgingold@som.umaryland.edu |
| Prot_002.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Apr 8, 2026 | May 20, 2026 | SAP_003.pdf |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D003920 | Diabetes Mellitus |
| D001249 | Asthma |
| D004194 | Disease |
| D029424 | Pulmonary Disease, Chronic Obstructive |
| D018805 | Sepsis |
| D006973 | Hypertension |
| D006333 | Heart Failure |
| D011014 | Pneumonia |
| D014552 | Urinary Tract Infections |
| D002637 | Chest Pain |
| D001523 | Mental Disorders |
| D000755 | Anemia, Sickle Cell |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001982 | Bronchial Diseases |
| D012140 | Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012130 | Respiratory Hypersensitivity |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D007239 | Infections |
| D018746 | Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D006331 | Heart Diseases |
| D012141 | Respiratory Tract Infections |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D000745 | Anemia, Hemolytic, Congenital |
| D000743 | Anemia, Hemolytic |
| D000740 | Anemia |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D006453 | Hemoglobinopathies |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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| Asian |
|
| Other |
|