Inpatient Hallway Research Articles

An initiative to reduce psychiatric boarding in a Cape Town emergency department.

Psychiatric boarding in Emergency Departments (ED) is a global challenge which results in long ED length of stays (LOS) with significant consequences on patient care and staff safety. This study investigated the impact of an initiative to reduce psychiatric boarding on LOS and readmission rate, as well as explored the relationship between boarding times and LOS. This study was conducted at Mitchells Plain Hospital, a large district-level hospital in Cape Town. This cross-sectional study collected data for 24 months, which included a 9-month period prior to the initiative and 16 months thereafter. Data were collected retrospectively from official electronic patient registries. The initiative comprised of inpatient hallway boarding as a full-capacity protocol with the accompanying capacitation of psychiatric wards to accommodate the additional burden. The initiative was associated with a decrease of 95% (p < 0.001) in boarding time, 13% (p < 0.001) in ward LOS and 25% (p < 0.001) in hospital LOS. Ward LOS were found to be independent of ED boarding times. The readmission rate increased from 12% to 18% post intervention. The initiative resulted in a sustainable improvement in boarding times and LOSs. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended. Inpatient hallway boarding could be a feasible option to reduce the risk. Psychiatric boarding times in the ED are independent of ward LOS, rendering it devoid from any value from a lean and economic perspective.

Emergency Department Hallway Care From the Millennium to the Pandemic: A Clear and Present Danger

BackgroundEmergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its progression. ObjectivesTo discuss reasons for ED crowding leading to hallway care, the impact of the coronavirus disease (COVID-19) pandemic, potential solutions, and why little has changed despite widespread awareness. DiscussionED crowding has been a public health issue for the past three decades, leading to patient care and boarding of admitted patients in ED hallways with limited resources. This care is often substandard and precarious. The COVID-19 pandemic placed further strain on the ED safety net, especially in certain urban areas. Despite recognition of the problem, publication of studies, and proposals offering many solutions, this problem continues to worsen. Corporate and hospital leadership must be made aware of the financial and legal ramifications for failure to address potential solutions, such as inpatient hallway boarding, provision of flexible expansion care areas, smoothing of elective admissions/surgeries, and efficient inpatient discharge flow. State and federal legislation may also be required to motivate this process. ConclusionsED crowding and hallway care will continue to worsen unless hospital leadership is willing to listen to ED staff concerns and address the problem on all levels of the hospital using previously proposed solutions. Emergency physicians should not fear termination for discussing this issue and its potential for poor clinical outcomes and ED staff morale.

Eliminating the Hawthorne Effect: Leveraging Existing Resources for a Novel Approach to Hand Hygiene Auditing

<h3>Background</h3> According to the Centers for Disease Control and Prevention healthcare-associated infections (HAI) affect 1 in 31 hospitalized patients. Despite the correlation between hand hygiene adherence and HAI reduction, compliance in hospitals is less than 40%. The gold standard method for a robust hand hygiene compliance program is to directly observe staff. However this is labor intensive and results can be confounded by the Hawthorne Effect. <h3>Methods</h3> Existing staff and technology were leveraged in novel ways to improve observation power. Infection prevention auditors were augmented by staff recruited from accreditation, quality and light duty nursing. Formalized auditor training fostered inter-rater reliability. Inpatient hallway security camera software was used by decentralized auditors to complete observations across all shifts. A digital hand hygiene survey was designed and implemented for real-time data entry. Total observation counts, compliance and trends were communicated to leadership and staff. Competition and reward recognition were used to facilitate change. A two-month pilot on select units was completed in 2018. This study was then expanded to all inpatient units and is ongoing. <h3>Results</h3> A total of 20 trained auditors (11 outside of infection prevention) have participated in this program. Over 1,000 observations per reporting period were recorded; this increased to over 2,000 monthly observations since September 2019. Hospital hand hygiene compliance has increased from 39% in 2018 to above 84% in 2019. <h3>Conclusions</h3> Current staff and existing security camera software support a robust hand hygiene direct observation program while minimizing resources invested and preventing the Hawthorne Effect. Ongoing data feedback to leadership and staff, competition, and staff recognition have maintained hand hygiene compliance rates above 84% exceeding the CDC 80% compliance threshold for significantly decreasing HAI risk.

What is full capacity protocol, and how is it implemented successfully?

BackgroundFull capacity protocol (FCP) is an internationally recognized intervention designed to address emergency department (ED) crowding. Despite FCP international recognition and positive effects on hospital performance measures, many hospitals, even the most crowded ones, have not implemented FCP. We conducted this study to identify the core components of FCP, explore the key barriers and facilitators associated with the FCP implementation, and provide practical recommendations on how to overcome those barriers.MethodsTo identify the core components of FCP, we used a non-experimental approach. We conducted semi-structured interviews with key informants (e.g., division chiefs, medical directors) involved in the implementation of FCP. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. We used a template analysis approach to determine the relevance of the CFIR constructs to implementing the FCP. We analyzed the responses to the interview questions about FCP definition and FCP key principles, compared different hospitals’ FCP official documents, and consulted with the original FCP developer. We then used an adaptation framework to categorize the core components of FCP into three main groups. Finally, we summarized practical recommendations for each barrier based on information provided by the interviewees.ResultsA total of 32 interviews were conducted. We observed that FCP has evolved from the idea of transferring boarded patients from ED hallways to inpatient hallways to a practical hospital-wide intervention with several components and multiple levels. The key determinant of successful FCP implementation was collaboration with inpatient nursing staff, as they were often reluctant to have patients boarded in inpatient hallways. Other determinants of successful FCP implementation were reaching consensus about the criteria for activation of each FCP level and actions in each FCP level, modifying the electronic health records system, restructuring the inpatient units to have adequate staffing and resources, complying with external regulations and policies such as fire marshal guidelines, and gaining hospital leaders’ support.ConclusionsThe key determinant in implementing FCP is creating a supportive and cooperative hospital culture and encouraging key stakeholders, including inpatient nursing staff, to acknowledge that crowding is a hospital-wide problem that requires a hospital-wide response.

Patient safety and quality outcomes for ED patients admitted to alternative care area inpatient beds

BackgroundInpatient hallway beds are one solution to mitigate emergency department (ED) crowding due to boarding of admitted patients. Alternative Care Areas (AltCA) beds are located in inpatient hallways, cardiac catheterization lab, and endoscopy. We examined whether AltCA beds were associated with increased risk of patient safety and quality outcomes: transfer to Intensive Care Unit (ICU), mortality, hospital-acquired infections (HAI), falls, and 72-hour hospital readmission. MethodsRetrospective cohort study of patients age >18 years admitted from the ED to non-ICU beds at an urban, academic hospital. AltCA bed exclusion criteria: dementia, frequent respiratory interventions, contact or airborne isolation, psychiatric admission, and inability to ambulate. The study periods were: pre-intervention 9/1/2014–3/31/2015, transition 9/1/2015–3/31/2016, and post-intervention 9/1/2016–3/31/2017. Data analysis used unadjusted and multivariable analyses which controlled for age, sex, race, ethnicity, insurance, ED triage Emergency Service Index (ESI) level, and telemetry order. ResultsThe study included 16,801 patients, with 622 (3.7%) patients in AltCA beds. AltCA beds had younger patients than standard inpatient beds, 57.7 years and 61.7 years; fewer telemetry order, 48.4% and 59.3%; and fewer ESI level 2, 16.1% and 26.2%. AltCA beds had shorter hospital LOS than standard inpatient beds, 2.7 days and 3.4 days. AltCA beds had decreased risk of transfer to ICU −10.6 (95%CI: −18.3, −2.8) and HAI −13.4 (95%CI: −20.3, −6.5) compared to standard inpatient beds. ConclusionPatients in AltCA beds did not have increased risk of patient safety and quality outcomes but rather decreased risk of transfer to ICU and HAI than standard inpatient beds.

Patient Preference for the Boarding at Emergency Department of Aseer Central Hospital when Emergency is Working with Its Maximum Capacity and Inpatient Admission is Full

Overcrowding in Emergency Department usually results in serious consequences such as delay in facilities, medical errors and medical complications as well. This occurs because delay in transfer of the patients from ED to inpatient departments. We conducted this study to know patients’ and their attendants preferences to stay in ED or to be shifted to in-patient units. Data was collected via Arabic translated questioner. A total of 316 applicants included in the study (after inclusion / exclusion criteria), 144 patients with 157 patient attendants. 75 (52.1%) were male, while 69 (47.9%) were females. The preferred area for boarding was ED curtained space for 77.8% of patients and 79% of patient watcher as compared to 11.8% patients and 15.3% attendants who accepted the admission to inpatient hallway (p- value 0.253). Regarding the comparison of boarding time (8 hours and 24 hours), 55.5% of patients preferred in ED with 8 hours scenario versus 29.9% who preferred inpatient hallway (p=0.0897). When 24 hours scenario was compared, it was found that 59% patients preferred ED while 49.7% preferred inpatient hallway (p= 0.252). Current study proves that collectively patients prefer to stay in ED (either curtained space or hallway); this is because the patients received quick facilities and attention from the staff. However, with 24 hours scenario, more patients now preferred to stay in in-patient hallway; this is because of delay in transfer of the patients from ED, and delay or lack in facilities which usually occur during overcrowding. We concluded that patient and their preferences differ in different settings. However, overcrowding in ED should be dealt seriously with transfer of patients to in-patient departments / wards as soon as possible to avoid medical errors and complications.

The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p &lt; .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p &lt; .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p &lt; .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

A cross-sectional study of emergency department boarding practices in the United States.

The median emergency department (ED) boarding time for admitted patients has been a nationally reportable core measure that now also affects ED accreditation and reimbursement. However, no direct national probability samples of ED boarding data have been available to guide this policy until now. The authors studied new National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items to establish baseline values, to generate hypotheses for future research, and to help improve survey quality in the future. This was a cross-sectional, multistage, stratified annual analysis of EDs and ED visits from the National Hospital Ambulatory Medical Care Survey public use files from 2007 to 2010, a total of 139,502 visit records. These data represent the only national measure of ED boarding. The main outcome of interest was boarding duration for individual patient visits. Data analyses accounted for complex sampling design. The national median boarding time was 79 minutes, with an interquartile range of 36 to 145 minutes. The prevalence of boarding for more than 2 hours among admitted patients was 32% (95% confidence interval [CI] = 30% to 35%). Average ED volume, occupancy, acuity, and hospital admission rates increased abruptly from the second to the third quartile of median boarding duration. The half of hospitals with the longest median boarding times accounted for 73% of ED visits and 79% of ED hospitalizations nationally. Thirty-nine percent of EDs (95% CI = 32% to 46%) reported never holding patients for more than 2 hours, but visit-level analysis at these EDs found that 21% of admissions did in fact stay in the ED over 2 hours. Only 19% of EDs (95% CI = 16% to 22%) used a strategy of moving admitted patients to alternative sites in the hospital during crowded times. In this national survey, ED boarding of admitted patients disproportionately affects hospitals with higher ED volumes, which also see sicker patients who wait longer to be seen, but not hospitals with higher proportions of Medicaid or uninsured visits. This finding implies that, unlike other quality measures, there is a negative volume-outcome relationship for timely hospitalization from the ED.

Patients Overwhelmingly Prefer Inpatient Boarding to Emergency Department Boarding

BackgroundBoarding of admitted patients in the emergency department (ED) is a major cause of crowding. One alternative to boarding in the ED, a full-capacity protocol where boarded patients are redeployed to inpatient units, can reduce crowding and improve overall flow. ObjectiveOur aim was to compare patient satisfaction with boarding in the ED vs. inpatient hallways. MethodsWe performed a structured telephone survey regarding patient experiences and preferences for boarding among admitted ED patients who experienced boarding in the ED hallway and then were subsequently transferred to inpatient hallways. Demographic and clinical characteristics, as well as patient preferences, including items related to patient comfort and safety using a 5-point scale, were recorded and descriptive statistics were used to summarize the data. ResultsOf 110 patients contacted, 105 consented to participate. Mean age was 57 ± 16 years and 52% were female. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. The overall preferred location after admission was the inpatient hallway in 85% (95% confidence interval 75–90) of respondents. In comparing ED vs. inpatient hallway boarding, the following percentages of respondents preferred inpatient boarding with regard to the following 8 items: rest, 85%; safety, 83%; confidentiality, 82%; treatment, 78%; comfort, 79%; quiet, 84%; staff availability, 84%; and privacy, 84%. For no item was there a preference for boarding in the ED. ConclusionsPatients overwhelmingly preferred the inpatient hallway rather than the ED hallway when admitted to the hospital.

The association between the transfer of emergency department boarders to inpatient hallways or off-service beds and the quality of oncology care.

113 Background: Emergency department (ED) crowding is an important issue in the delivery of high-quality medical care. At our quaternary care hospital a policy was implemented to ease ED crowding by moving suitable admitted patients into inpatient hallway beds or off-service beds. This study assesses the impact of off service and hallway bed admissions on patient care and satisfaction. Methods: Retrospective and prospective data were collected from Jan 1 to Dec 31, 2011, on admissions to the oncology service via the ED. Patient care data was collected as follows: chest/abdominal exams performed at first MD visit, number of MD visits within 48 hours, time to antibiotic administration, time to complete vitals, and mean time spent in the ED. Satisfaction surveys were also given to all patients. Results: One hundred and eighteen patients were admitted to a hallway bed (HALL). A random sample of 90 patients were used for comparison in the on service (ON) and off service (OFF) groups. Among HALL patients, 4% percent discharged themselves against medical advice (0% of OFF and ON patients). MD visits within 48 hours were the same among all groups (mean=6). Forty-two percent of hallway patients had a chest/abdominal exam during the first MD visit (32% and 33% for OFF and ON patients, respectively). Time to first completion of vitals was 1:05 (hh:mm) for HALL patients (1:21 and 00:34 for OFF and ON patients, respectively). Time to antibiotic administration was 15:34 for hallway patients (23:59 and 12:35 for OFF and ON patients, respectively). More HALL patients expressed dissatisfaction with their hospital stay (16.7%) compared to OFF (0%) and ON patients (0%). Mean time for admitted patients in the ED awaiting their HALL bed was 9:14, considerably longer than for OFF patients (3:08) and ON patients (4:19). Conclusions: Admission of oncology patients in hallway or in off-service beds did not appear to compromise the timeliness or frequency of medical assessments. However, delays in nursing care (completion of vital signs and drug administration) were noted and patient satisfaction was decreased. Moreover, the policy did not meet its intent to reduce patient time spent in the ED.

Comparison of emergency physicians and internists regarding core measures of care for admitted emergency department boarders with pneumonia

The inability to admit emergency patients to inpatient beds is the single most important causes of emergency department (ED) crowding. ED crowding increases frustration, risks of medical errors and poor outcomes. Delays to admission are associated with increased inpatient length of stay, cost and mortality. Nevertheless, no patient harm was found in selected ED-boarded admitted patients who were relocated to an inpatient hallway and were cared by internists. To compare quality of cares and short-term outcomes in emergency department boarders admitted for pneumonia cared by the emergency physician (EP) and the internist. This is a retrospective, cross-sectional study in a tertiary referral hospital. We board admitted patients in the ED observation units when there is no inpatient bed and transfer is not available. Besides EPs, internists cared parts of boarders from February 1st to August 31st in 2010. We retrieved admitted pneumonia patients, aged 18 years or older, who boarded in the ED longer than 6 hours. We excluded patients with severe pneumonia admitted to intensive care units, human immunodeficiency virus infection, leukemia or lymphoma diagnosed within 3 months, bronchiectasis, malnutrition, or who receiving systemic chemotherapy, immunosuppression therapy, comfort care, based on established instrument of quality measures. Enrolled patients were stratified into EP or internist caring groups. We collected their demographics, co-morbidities, symptoms, vital signs, and laboratory results. Severity of the pneumonia was assessed by the pneumonia severity index and the CURB-65 score. Quality of care was assessed by established core measures. We analyzed dichotomous variables with the Fisher's exact test. For continuous variables, we used the Student's t test for paramedic variables, and the Mann-Whitney U test for non-parametric variables. Difference was considered as significant at a p level of 0.05. Ninety-four patients were enrolled: 59 cared by EPs and 35 by internists. Between EP and internist caring groups, there was no significant difference in age, sex, and pneumonia severity. In the core measures of quality, there was no significant difference in oxygenation assessment, first antibiotics within 6 hours of presentation, blood culture before antibiotic administration, and proper antibiotics within 24 hours. Internists provided more smoking counseling (31.4% vs 10.2%; p = 0.013). Both EP and internist did little vaccination counseling. In short-term outcomes, no difference was found in length of stay, late ICU admission, unscheduled ED returns, and 30-day readmission or mortality rates. For ED boarders admitted for pneumonia, EPs provided less smoking counseling than internists. However, there was no significant difference in other core measures of quality and short-term outcomes.

27 Patients Prefer Boarding in Inpatient Hallways: Correlation With the National Emergency Department Overcrowding Score (NEDOCS)

The boarding of patients in emergency department (ED) hallways when no inpatient beds are available contributes to ED crowding. One solution is to board admitted patients in an inpatient setting rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to a real-time measurement of crowding, NEDOCS.

Patients Prefer Boarding in Inpatient Hallways: Correlation with the National Emergency Department Overcrowding Score

Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS). Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0–200) was 136 ± 46 for patients preferring inpatient boarding, 112 ± 39 for ED boarding, and 119 ± 43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

Emergency department over-crowding: a global perspective

Emergency department over-crowding: a global perspective

141: Patient Satisfaction of Emergency Department Boarders With Inpatient Hallway Admission

141: Patient Satisfaction of Emergency Department Boarders With Inpatient Hallway Admission

The Association Between Transfer of Emergency Department Boarders to Inpatient Hallways and Mortality: A 4-Year Experience

We developed and implemented an institutional protocol aimed at reducing crowding by admitting boarded patients to hospital inpatient hallways. We hypothesized that transfer of admitted patients from the emergency department (ED) to inpatient hallways would be feasible and not create patient harm. This was a retrospective cohort study in a suburban, academic ED with an annual census of 70,000. We studied consecutive patients admitted from our ED between January 2004 and January 2008. In 2001, a multidisciplinary team developed and implemented an institutional protocol in which admitted adult patients boarded in the ED were transferred to hospital inpatient hallways under select conditions. We extracted data from the electronic medical record system, measuring patient demographics, ED disposition (discharge, admit to floor, admit to hallway), ED length of stay, and inhospital mortality. We report ED length of stay, subsequent transfer to an ICU, and hospital mortality of patients admitted to standard and hallway inpatient beds. Of 55,062 ED patients admitted, there were 1,798 deaths. Of all admissions, 2,042 (4%) went to a hallway; 53,020 went to a standard bed. Patients admitted to standard and hallway beds were similar in age (median [interquartile range] 55 years [37 to 72 years] and 54 years [41 to 70 years], respectively) and sex (48.2% and 50% female patients, respectively). The median (interquartile range) times from ED triage to actual admission in patients admitted to standard and hallway beds were 426 minutes (306 to 600 minutes) and 624 (439 to 895 minutes) minutes, respectively (P<.001). Median ED census at triage was lower for standard bed admissions than for hallway patients (44 [33 to 53] versus 50 [38 to 61], respectively, P<.001). Inhospital mortality rates were higher among patients admitted to standard beds (2.6%; 95% confidence interval [CI] 2.5% to 2.7%) than among patients admitted to hallway beds (1.1%; 95% CI 0.7% to 1.7%). ICU transfers were also higher in the standard bed admissions (6.7% [95% CI 6.5% to 6.9%] versus 2.5% [95% CI 1.9% to 3.3%]). Transfer of ED-boarded admitted patients to an inpatient hallway occurs during high ED census and waiting times for admission but does not appears to result in patient harm.

Parental Preferences for Boarding Locations When a Children's Hospital Exceeds Capacity

Our objective is to determine parental preferences for boarding locations when a children's hospital is at full capacity. We also assess parental interest in transfer to a general hospital when a children's hospital is experiencing crowding. Eligible patients were surveyed within 24 hours of admission. Surveys were completed in emergency department (ED) and inpatient areas. Previous admission was not required; children with chronic illnesses were included. Parents were asked whether they would prefer their child to board in an ED hallway or inpatient hallway or whether they had no preference. Parents were also asked the maximum acceptable waiting time for an inpatient bed and whether they would prefer to be transferred to another hospital should the children's hospital not have a bed available. Responses were hypothetical and confidential and did not affect care. A total of 382 patients met enrollment criteria and 359 (94%) were enrolled; 58.8% (95% confidence interval [CI] 53.5% to 63.9%) preferred boarding on inpatient hallways, 11.1% (95% CI 8.2% to 15.0%) preferred ED hallways, and 30.1% (95% CI 25.4% to 35.2%) had no preference. Seventy percent (95% CI 65.2% to 74.9%) of parents preferred to wait at a children's hospital despite crowding. Most parents believed that the maximum acceptable waiting time was less than or equal to 3 hours. Parents of pediatric patients prefer boarding on inpatient hallways over ED hallways. The majority of parents prefer to remain at a children's hospital despite crowded conditions, but some parents may be amenable to transfer. These results may help institutions develop strategies to improve patient satisfaction when hospital capacity is exceeded.

Is It Safe to Admit Boarder Patients to Inpatient Hallways

Caring for emergency department patients in hallways has become the norm as hospital crowding has become pervasive. One approach to reducing ED crowding during times of high ED and inpatient census is to augment inpatient capacity by admitting selected ED boarder patients to hallways on inpatient floors, instead of boarding them in the ED. This approach essentially “shares the pain” of hospital crowding. In a …

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

6: Transfer of Emergency Department Boarders to Inpatient Hallways: A Four-Year Experience

A recent IOM report highlighted ED crowding and the contribution of emergency department (ED) boarding of admitted patients to this crisis. We developed and implemented an institutional protocol aimed at reducing crowding by admitting boarded patients to hospital in-patient hallways. We describe our experience with this protocol over the last 4 years.