National Daily Hospital News — Special Report ED Boarding SBAR
Topic: Cutting ED Boarding by Shifting Discharges Earlier in the Day (Discharge-by-Noon)
Date: October 31, 2025
Situation
U.S. hospitals continue to face ED boarding driven by inpatient capacity constraints and late-day discharges. Evidence from 2025 shows that earlier discharge timing (e.g., discharge-by-noon) is one of the fastest system-level levers to free beds and shorten ED length of stay. See AHRQ’s 2025 briefing on ED boarding and hospital-wide drivers: https://www.ahrq.gov/news/newsletters/e-newsletter/951.html
Background
Boarding persists when admitted patients wait in the ED for an inpatient bed because units have not yet turned beds over. In 2025, research and national analyses reframed boarding as a hospital-wide flow issue—not just an ED problem—tied to discharge processes, bed placement, and post-acute access. A JAMA Network Open study (2025) associated high ED boarding with 29% lower odds of accepting interhospital transfers, underscoring regional access and patient-safety implications:
Article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834521
Open-access (PMC): https://pmc.ncbi.nlm.nih.gov/articles/PMC12120653/
Operational playbooks emphasize earlier multidisciplinary rounding, clear “inpatient-ready” criteria, and daily capacity huddles to move discharge order times earlier—unlocking beds before peak ED admit demand. See ACEP Quality & Patient Safety (Feb 2025): https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experience
Action
Implement a hospital-wide Discharge-by-Noon program that couples:
Daily inpatient huddles (by 9–10 AM) to confirm discharge-today patients and remove barriers.
Bed placement coordination with a real-time digital bed board and “inpatient-ready” admit criteria.
Standard work for earlier rounding, earlier transport, early pharmacy/therapy/EVS triggers, and post-acute coordination.
Reference guidance and U.S. context for 2025:AHRQ overview on boarding causes/solutions: https://www.ahrq.gov/news/newsletters/e-newsletter/951.html
ACEP operations case guidance: https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experience
Results — Five 2025 Case Studies
Transfer acceptance harmed by boarding (national, multi-state). Worst-quartile ED boarding associated with aOR 0.71 for accepting transfers—quantifying access risk and the value of freeing beds earlier in the day.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834521 | https://pmc.ncbi.nlm.nih.gov/articles/PMC12120653/One-institution ED throughput program (ACEP QIPS, Feb 2025). Standardized inpatient-ready criteria, rapid admit processes, and daily flow huddles reduced internal holds and ED LOS.
https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experienceNational capacity context (Vizient, Jun 2025). U.S. hospitals shed ≈30,000 beds (2019–2022) while acuity rose—elevating the impact of discharge-timing work on ED crowding.
https://www.vizientinc.com/insights/all/2025/from-every-angle-emergency-department-overcrowdingDischarge-by-noon project (Valparaiso University EBPR, 2025). Structured discharge planning and earlier rounding improved percent of discharges before noon and reduced inpatient LOS.
https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1213&context=ebprBed placement and cohorting playbook (HAP/Penn Medicine, May 2025). Flow governance plus cohorting and earlier discharge targets improved throughput and bed availability.
https://www.haponline.org/Portals/1/docs/Events-and-Education/2025-Leadership-Summit/6WoodHAP5122025.pdf
Quality Metrics From These Case Studies
Odds of accepting interhospital transfers drop to aOR 0.71 at worst-quartile ED boarding (JAMA Network Open, 2025).
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834521 | https://pmc.ncbi.nlm.nih.gov/articles/PMC12120653/Beds removed nationally: ≈30,000 beds (2019–2022), intensifying need for discharge-timing fixes (Vizient, 2025).
https://www.vizientinc.com/insights/all/2025/from-every-angle-emergency-department-overcrowdingDischarge-by-noon target: ≥30% of daily discharges as a practical hospital-wide goal (EBPR & U.S. throughput programs, 2025).
https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1213&context=ebprED boarding is system-level (capacity, discharge timing, post-acute access) per AHRQ summary (2025).
https://www.ahrq.gov/news/newsletters/e-newsletter/951.htmlTactics that shorten ED LOS: inpatient-ready criteria, rapid admit flow, and daily 10 AM capacity huddles (ACEP QIPS, 2025).
https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experienceLOS reduction without higher readmits via enhanced recovery and daily multidisciplinary rounds (peer-reviewed review, 2025).
https://pmc.ncbi.nlm.nih.gov/articles/PMC12112870/Winter risk marker: boarding peaks with ≥4-hour holds in ~35% of admits and ~5% ≥24 hours (2024 data reported 2025).
https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experience
If you need a single composite figure for expected ED LOS improvement from discharge-by-noon programs across diverse hospitals, our assessment today from a broad survey of current open-access reports suggests 10–20% ED LOS reduction when discharge-by-noon reliably reaches ≥30% for several months. This figure is an assessment made today from a broad survey of currently available data and is not a robust meta study.
Leadership Project Plan — Discharge-by-Noon / Boarding Reduction (8-week)
(Assume project begins Mon, Nov 3, 2025; adjust dates as needed. No tables.)
Week 1 (Nov 3–7): Initiate & Baseline
Appoint executive sponsor (COO/CMO) and flow lead (bed management or nursing admin).
Capture baselines: ED boarding hours, ED LOS (admit & discharge), % discharges before noon, inpatient LOS, time-to-clean bed.
Stand up daily 10:00 AM capacity huddle; publish definitions (boarding hour, inpatient-ready criteria).
Select two pilot units (e.g., Med-Surg, Ortho).
Week 2 (Nov 10–14): Standard Work & Visibility
Map discharge workflow from morning rounds → transport → EVS → bed ready.
Create standard work for earlier rounds, discharge planning at admission, and early day transport/EVS triggers.
Launch real-time digital bed board with admit “inpatient-ready” visual.
Post unit dashboards (boarding hours, % DBN).
Week 3 (Nov 17–21): Pilot Execution
Pilot Discharge-by-Noon on two units; set target ≥30% of discharges before noon.
Remove top 3 barriers daily (med rec, transport, EVS sequencing).
Daily feedback loop to ED and hospitalists.
Week 4 (Nov 24–28): Scale Enablers
Expand pharmacy, therapy, and case management early-day coverage for pilot units.
Align post-acute partners (SNF/home health) for AM pickups and early orders.
Validate billing/coding impacts (no revenue leakage from earlier discharge timing).
Week 5 (Dec 1–5): Spread to Additional Units
Add two more units; confirm EVS staffing aligns to AM discharge peak.
Implement “expected discharges tomorrow” list by 3 PM each day (next-day readiness).
Week 6 (Dec 8–12): Hardwire Bed Placement
Formalize inpatient-ready criteria; empower bed placement to assign on criteria without delays.
Introduce rapid-admit unit/process for admits holding >2 hours in ED.
Week 7 (Dec 15–19): Optimization
Review metrics; target 10–20% ED LOS reduction and ≥30% DBN on all participating units.
Conduct case reviews of longest boarding holds; fix root causes (transport/consult timing).
Week 8 (Dec 22–26): Sustain & Spread
Lock standard work; integrate into charge nurse checklists and hospitalist service agreements.
Publish monthly scorecard (boarding hours, ED LOS, % DBN, time-to-clean bed).
Plan next wave (remaining units, weekends/holidays coverage).
References to guide weekly work:
AHRQ boarding summary: https://www.ahrq.gov/news/newsletters/e-newsletter/951.html
ACEP operations case: https://www.acep.org/qips/newsroom/winter-2025/optimizing-throughput-in-the-emergency-department-one-institutions-experience
JAMA transfer risk: https://pmc.ncbi.nlm.nih.gov/articles/PMC12120653/
Vizient capacity context: https://www.vizientinc.com/insights/all/2025/from-every-angle-emergency-department-overcrowding
EBPR discharge-by-noon project: https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1213&context=ebpr
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