• Namita Jayaprakash, Jacqueline Pflaum-Carlson, Jayna Gardner-Gray, Gina Hurst, Victor Coba, Harish Kinni, and John Deledda.
• Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI. Electronic address: njayapr1@hfhs.org.
• Ann Emerg Med. 2020 Dec 1; 76 (6): 709-716.

AbstractThe National Academy of Medicine has identified emergency department (ED) crowding as a health care delivery problem. Because the ED is a portal of entry to the hospital, 25% of all ED encounters are related to critical illness. Crowding at both an ED and hospital level can thus lead to boarding of a number of critically ill patients in the ED. EDs are required to not only deliver immediate resuscitative and stabilizing care to critically ill patients on presentation but also provide longitudinal care while boarding for the ICU. Crowding and boarding are multifactorial and complex issues, for which different models for delivery of critical care in the ED have been described. Herein, we provide a narrative review of different models of delivery of critical care reported in the literature and highlight aspects for consideration for successful local implementation.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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