https://doi.org/10.4081/ecj.2026.15158
Boarding beyond the emergency department: inpatient physicians’ perspectives from a hospital-wide survey
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Published: 16 June 2026
Emergency Department (ED) overcrowding and boarding are increasingly recognized as hospital-wide phenomena related to patient flow and inpatient bed capacity, rather than isolated ED operational issues. However, little is known about how inpatient physicians perceive ED admissions and their relationship with boarding. The authors aim to explore inpatient physicians’ perspectives on the appropriateness of ED admissions and their perception of boarding as a system-level issue. We conducted a single-center cross-sectional survey of heads of inpatient medical wards in a large tertiary academic hospital, IRCCS Azienda Ospedaliero-Universitaria – Policlinico di Sant’Orsola, Bologna, Italy. The questionnaire investigated ward characteristics, perceived alignment between ED admissions and ward skill mix, organizational consequences of mismatches in admissions, and perceptions of ED boarding. Administrative data on ED admissions and Diagnosis-Related Groups (DRGs) were incorporated to contextualize responses. Descriptive statistics were used to summarize survey results. Sixteen ward heads participated (response rate 100%). Alignment between ED admissions and the ward clinical profile was perceived as moderate. Inappropriate admissions were perceived as being mainly associated with organizational consequences, particularly longer hospital length of stay and resource waste, rather than major clinical outcomes. All respondents recognized ED boarding as a hospital-wide issue and reported frequently receiving boarded patients. Inpatient physicians perceive ED boarding as a system-level phenomenon linked to hospital capacity and patient flow. Improving alignment between patient needs, departmental expertise, and hospital resources may therefore represent a key organizational strategy for addressing hospital overcrowding and ED boarding.
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CRediT authorship contribution
Mario Corciulo and Claudio Borghi contributed to the conception and design of the study. Mario Corciulo and Davide Pianori designed the survey. Fabrizio Giostra revised the survey and the dataset. Mario Corciulo analyzed and interpreted the data, performed the statistical analysis, and drafted the manuscript. Eleonora Tubertini and Davide Agnoletti critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
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