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Emergency Department (ED) boarding–prolonged stays in the ED while awaiting inpatient placement–is a crisis exacerbating crowding, increasing costs, and negatively impacting health outcomes. Vulnerable populations, including individuals with low socioeconomic status (SES), medically-complex older adults, and psychiatric patients are disproportionately affected. Yet, solutions tailored to their needs remain underexplored. This discussion examines root causes of boarding and proposes innovative, scalable interventions to mitigate its harms, specifically for marginalized groups. We highlight three strategies: (1) Patient Navigators, who assist low-SES patients navigating healthcare systems, (2) Community Paramedicine, which delivers in-home care to complex patients, and (3) Emergency Psychiatric Assessment, Treatment and Healing (EmPATH) Units, which provide targeted care for psychiatric patients. All three are associated with reduced ED visits. Traditional approaches to boarding have fallen short, particularly for vulnerable populations. Patient navigation, Community Paramedicine, and EmPATH units represent feasible, evidence-based solutions that health systems can implement. Broader adoption of these models can alleviate crowding, enhance care quality, and promote health equity. Future efforts must align these innovations with policy and funding mechanisms to ensure sustainable, system-wide improvements.
