State Approaches to Boarding & Crowding

As emergency departments throughout the country deal with the problems of crowding, boarding and ambulance diversion, some chapters have sought relief through state legislative and regulatory action. The resources on this page provide examples of these state legislative and regulatory approaches. 

Minnesota Emergency Department Boarding of Patients with Psychiatric Diagnoses (EDBPPD)
A 2023 joint report from the Minnesota Medical Society/Minnesota ACEP Taskforce to end ED boarding. 

Pennsylvania Department of Health Statement on Boarding and Crowding
A 2011 letter from the Pennsylvania Department of Health to hospitals regarding boarding and crowding.

Virginia Department of Health Boarding Guidance for Hospitals
Guidelines to assist hospitals in developing policies and procedures for boarding admitted patients.

Model Boarding Resolutions Passed by State Medical Societies
These two resolutions approved by the state medical societies in Texas and New Mexico are prime examples of how chapters can enlist the support of the larger medical community within their states to actively support meaningful efforts to address boarding problems.

State and Local Efforts to Address Boarding and Crowding
An information paper developed by the 2008-2009 State Legislative/Regulatory Committee with information from ACEP chapters about local programs and state legislative initiatives designed to address problems associated with boarding and crowding.

MA DPH and Fire Marshal Policies on Moving Boarded Patients
A 2009 letter addressing hospital fire protection and evacuation plans relative to the ongoing problems of hospital emergency department crowding and patient boarding.

MA DPH Letter to Hospitals to Address Boarding
A 2009 guidance on reducing or eliminating the need for boarding patients in the emergency department during flu season.

Massachusetts Ruling Prohibiting Ambulance Diversion
A 2008 directive from the Massachusetts Department of Public Health prohibiting the practice of ambulance diversion except in extreme cases and instructing hospitals to improve patient flow practices to alleviate boarding of patients in the emergency department.

New Jersey DOH Letter to Hospitals - Boarding in Inpatient Areas OK and Better than in EDs
A 2004 letter from the New Jersey Department of Health instructing hospitals that they will be permitted to place patients in inpatient halls under certain circumstances.