ICUs play a growing role in the healthcare system, and the care that they enable would have been almost unrecognizable only decades ago (1–3). Technological advancement in mechanical ventilators, circulatory support devices, and renal replacement therapies, coupled with pharmacologic innovation in antimicrobials, anticoagulants, immune modulators, and chemotherapy have made possible survival for patients previously thought to have incurable disease (2,3). However, few ICUs have seen the same degree of innovation in the daily cadence of clinical activities: morning rounding, bedside house-staff teaching, discussions with consultants, planned procedures, new admission “tuck-ins,” and afternoon discharges remain the current norm. Has our ICU care model innovated to respond to our expanding health system needs? “Critical care medicine is a mindset, not a location” (4). But what exactly defines critical care medicine at its core? The Society of Critical Care Medicine describes a multidisciplinary intensivist-led team with critical care nurses, pharmacists, respiratory therapists, registered dieticians, advance practice providers, physical/occupational therapists, patient care assistants, and others dedicated to the care of the critically ill. Critical care is a 24/7 enterprise with continuous monitoring and intervention. It incorporates team-based communication, patient-centered plans, and time at the bedside to delineate care (5). Critical care provides infrastructure to respond to the evolution of disease, using diagnostics, measuring response to interventions, and providing evidence-based care (3). This “bundle” of critical care is ubiquitous in modern ICUs, but can the same outcomes be achieved with only components of that full bundle? Emergency departments (EDs) occupy a unique niche in our healthcare system, diagnosing patients early in the course of disease, stabilizing critical illness, and identifying destinations for ongoing care (6,7). EDs are organized to provide rapid time-sensitive care to anyone 24/7, but what happens when patient disposition is delayed? Crowding in the ED is a growing healthcare and societal emergency (8). Often, critically ill patients remain in an ED for many hours waiting for capacity in other parts of our health system to provide a true multidisciplinary critical care environment. Many proposed solutions have been explored to substitute for ICU-based care and reduce disparities in outcomes—some healthcare systems have adopted ED-based ICUs, tele-ICU models, observation/step-down units, or even redeployment of nursing personal. Which components of the critical care “bundle” are most needed outside the ICU to provide the right care, right now? In this issue of Critical Care Medicine, Mitarai et al (9) present a novel Emergency Critical Care Physician (ECCP) consult model used in a large academic center to provide care for critically ill patients in the ED. Their model included a board-certified emergency intensivist consultation with a dedicated bedside critical care nurse during the busiest part the day: 2 pm until midnight. Instead of being evaluated by an ICU-based team, patients scheduled for medical ICU admission were treated by the ECCP service. Subsequent interventions, procedures, documentation, and stabilization was managed by the ECCP intensivist in the ED. In a difference-in-difference analysis spanning 4 years, they showed that adjusted mortality decreased by 6%, with the greatest effect in those with intermediate illness severity. In parallel, their model was associated with increased ED downgrades to non-ICU care in a group with intermediate illness severity (9). Although not reported in their article, the model also presumably allowed the team in the medical ICU to continue to provide high-quality care to patients in the ICU, potentially improving care and outcomes for patients already admitted. The authors should be commended for their innovation to expand needed critical care services to their patients’ bedsides and removing the physical barrier of an ICU room. However, is this the desired solution to the problem of health system capacity and crowding? EDs are increasingly stretched by several high-priority competing demands, and critically ill patients are one population for whom boarding has been shown to cause harm (8). Like treating patients in waiting rooms (7), boarding inpatients in hallways, and developing ED response teams, does this solution actually solve the problems of hospital capacity that plague modern healthcare? With the goal of getting the right care, right now, are we simply obscuring the deeper problem in our current inability to provide adequate capacity and patient flow for the critically ill patients? Our health system needs to be introspective about the causes of the current capacity crisis. Implementing critical care principles for patients in the ED makes sense. However, does an intensivist/nurse consultation model truly represent the multidisciplinary critical care environment of a well-run ICU? That team-based multidisciplinary care model requires technology, diverse members of a care team, and time for reevaluation that are afforded within in the ICU. Studies of harm reduction countermeasures for boarding are critically important, and the authors should be applauded for demonstrating the effectiveness of their intervention, but we cannot forget that these countermeasures are needed because of a crisis in hospital capacity and throughput and that effective interventions demonstrate the unintended harms associated with the current state of health system crowding. The other finding from Mitarai et al (9) that deserves comment is the patient group most associated with benefit from the ECCP intervention—those with intermediate illness severity. These patients may have had unrecognized illness severity, or their trajectory may have been evolving even during their period of ED boarding. Future work will need to elucidate the exact components of critical care interventions most associated with benefit. Understanding the specific treatments that matter (titration of support, recognition of clinical change, or early implementation of standard care paradigms) will be important to maximize benefit from layering isolated critical care resources outside the package of services available in the ICU. Crowding and boarding are not just problems in the ED (8,10). Flow and capacity problems plague many aspects of the acute healthcare system—boarding patients can be found on hospital wards, in ICUs, in the post-anesthesia care unit, in psychiatric facilities, and in rural hospitals waiting for available beds in tertiary centers. Does downgrading an ED patient from ICU status really represent success, or does this just offload boarding from one place to another? The downgraded patient is still waiting in a crowded ED. Exploring strategies for rapid ICU resuscitation, recognition of improvement, evidence-based transfer policies, and improved bed turnover may challenge the cadence of the ICU, but it could also be an effective strategy to maintain hospital capacity and throughput in a complex healthcare system. Future work on boarding mitigation should continue to prioritize critical care collaboration. Our goal as intensive care practitioners should be to provide multidisciplinary critical care, regardless of hospital location. Mitarai et al (9) have elegantly demonstrated how effective simple interventions can be to improve acute survival and resource utilization in the critically ill. This work should be celebrated, but it should also focus our attention on the underlying capacity and throughput factors in our hospitals that lead to a routine boarding crisis in our nation’s EDs. Critical care medicine is the multidisciplinary mindset that can stimulate interprofessional partnership for solutions to make meaningful patient-centered change—to deliver the right care, right now.