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CompletedNCT07532564Updated Jun 17, 2026Results posted

Risk Factors, Costs, and Impacts of ED Boarding

An observational study in Stroke (CVA) or TIA, Diabetes and Asthma (Diagnosis), sponsored by University of Maryland, Baltimore. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-06-17.

Sponsored by University of Maryland, Baltimore · Observational

Study type
Observational
Model
Cohort
Time perspective
Cross-sectional
Enrollment
30,486
Ages
18 Years and older
Sex
All
01

Study summary

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:

  1. What characteristics of patients make them more likely to experience ED boarding?
  2. What is the impact of ED boarding on costs of health care?
  3. How do high-boarding environments affect the clinical care of all patients in the emergency department, including those that do not board themselves.

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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Conditions studied

  • Stroke (CVA) or TIA
  • Diabetes
  • Asthma (Diagnosis)
  • COPD (Chronic Obstructive Pulmonary Disease)
  • Sepsis
  • Hypertension
  • Heart Failure
  • Pneumonia
  • Urinary Tract Infection (Diagnosis)
  • Chest Pain
  • Psychiatric Disorder
  • Sickle Cell Disease (SCD)

Keywords

  • emergency department boarding
  • health care costs
  • emergency department operations
  • health services research
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In context

Stroke

7,283 studies on the registry are indexed under Stroke; 2,013 are open to participants now.

This study's enrollment of 30,486 is above the median of 160 across 1,692 observational studies indexed under Stroke.

Browse Stroke studies →

Lead sponsor

University of Maryland, Baltimore is the lead sponsor of 687 studies on the registry; 130 are open to participants now.

Of its 90 completed or terminated interventional studies of FDA-regulated products, 63 (70%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes
Sampling method
Non-probability sample

Study population

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)

Inclusion criteria

  • adults (> 18 years old) presenting to UMMS system hospitals ED
  • Patients hospitalized by inpatient or observation status over study period (2022-2025)
  • Admitted to a service that directly manages boarding patient in the ED. At UMMC, patient should be admitted to an internal medicine team Med 1-4, Med 6, Med 5, med/surg/tele level (no IMC/ICU) and neurology floor level.

Exclusion criteria

Exclusion Criteria:

  • Patients admitted to cardiology, cancer center, surgical services
  • Patients admitted to not floor level status (IMC/ICU)
05

Study design

Observational model
Cohort
Time perspective
Cross-sectional
Enrollment
30,486 participants (actual)
Patient registry
No

Groups and cohorts

  • 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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What researchers measure

Primary outcomes

  1. 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

    Time frame: During enrollment hospital encounter, up to 300 days

07

Results

Posted Jun 17, 2026

Participant flow

Participant flow — Overall Study
MilestonePatients Hospitalized From the ED to Boarding Services
Started30486
Completed30486
Not completed0

Outcome measures

PrimaryBoarding 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

Time frame:
During enrollment hospital encounter, up to 300 days
Reported as:
Mean · Hours
Boarding Time
HoursPatients Hospitalized From the ED to Boarding Services
Boarding Time24.4 ± 20

Adverse events

Collected over from enrollment, up to 365 days. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Patients Hospitalized From the ED to Boarding Services0/18,526 (0%)0/18,526 (0%)0/18,526 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)Patients Hospitalized From the ED to Boarding Services
Median58 (47 to 70)
Sex: Female, Male
Sex: Female, Male(Participants)Patients Hospitalized From the ED to Boarding Services
Female9323
Male9203
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Patients Hospitalized From the ED to Boarding Services
Black12216
White5293
Asian239
Other778
Region of Enrollment
Region of Enrollment(Participants)Patients Hospitalized From the ED to Boarding Services
United States18526
Commercial Payor
Commercial Payor(Participants)Patients Hospitalized From the ED to Boarding Services
Count of participants2682
08

Study locations

1 site
  • University of Maryland Medical Center
    Baltimore, Maryland 21201, United States
09

References and documents

Publications

  • 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. PubMed 31738715 ↗
  • 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. PubMed 30161242 ↗
  • 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. PubMed 12957975 ↗
  • 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. PubMed 14709427 ↗
  • 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. PubMed 10029127 ↗
  • 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. PubMed 28611873 ↗
  • 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. PubMed 38795079 ↗
  • 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. PubMed 34125054 ↗
  • 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. PubMed 19088342 ↗
  • 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. PubMed 34546898 ↗
  • 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. PubMed 23218508 ↗
  • 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. PubMed 28233644 ↗
  • 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. PubMed 36614835 ↗
  • 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. PubMed 22168198 ↗
  • 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. PubMed 32294111 ↗
  • 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. PubMed 36766963 ↗
  • 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
  • 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. PubMed 40456033 ↗

Study documents

  • Study protocol · Apr 8, 2026
  • Statistical analysis plan · Apr 8, 2026

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No — Risk of violating HIPAA and patient privacy without patient consent.

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 17, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07532564
Lead sponsor
University of Maryland, Baltimore
Responsible party
Daniel Gingold (Assistant Professor, University of Maryland, Baltimore) — Principal investigator
First posted
Apr 16, 2026
Start date
Jan 1, 2022
Primary completion
Dec 31, 2025
Completion
Dec 31, 2025
Results posted
Jun 17, 2026
Last update
Jun 17, 2026

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in May 2026. You cannot join it, but the record below documents what was studied.

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