ADMIN & CLINICAL OPERATIONS
ED Hallway Beds: The Patient Experience, Drawbacks, and Potential Solutions
SAEM PULSE | NOVEMBER-DECEMBER 2022
By Derrick Huang, MD; Meagan Hunt, MD; Tehreem Rehman, MD, MPH; Max Kravitz, MD, MBA; and Megan Davis, MD, MBA, on behalf of the SAEM ED Administration and Clinical Operations Committee
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Emergency department (ED) overcrowding is becoming more prevalent across the nation. This problem occurs when the demand for patient care in the ED exceeds the number of bays or rooms in which the emergency medicine team can provide care. Unsurprisingly, overcrowding has been associated with worse health outcomes, decreased patient satisfaction, and physician burnout. Indeed, when the patient volume in the ED exceeds room capacity, patients may need be seen in hallway beds as opposed to private rooms. Unfortunately, institutional failures to address inpatient boarding in our EDs create a visible inequity in care for our patients. Is it any surprise that patients ask, “Why am I being the one seen in the hallway?”
The Benefits of Hallway Beds
Why would EDs resort to care in hallway beds when such an approach can negatively impact the satisfaction of care for patients and their families? The simple answer is that hallway spaces add capacity and one of the biggest drivers of patient satisfaction is wait time. Increasing capacity with hallway beds decreases the time a patient must wait to be seen. Hallway beds are also dynamic, simple to operationalize, and free to implement. They allow departments to “flex up” as needed during busier days and times. This impermanent solution comes at no cost to our hospitals and can be employed immediately by ED care teams desperate to care for more patients. Most importantly, this allows ED teams to decompress lower acuity
patients quickly to reduce overcrowding in swelling lobbies as quickly as possible when a volume surge occurs.
The Drawbacks
Unfortunately, patient care in hallway beds is associated with worse health outcomes. Care in the hallway goes beyond its strong association with prolonged length of stay and dissatisfaction from both patients and staff. Outside of a private room, hallway patients do not have access to the same level of electronic monitoring. The bedside nurse may be providing care that exceeds his or her usual patient load. While lower acuity patients can be managed in this scenario without safety concerns in many cases, the patient experience is that he or she is the lowest priority in the nurse’s assignment and often in their provider’s work list.
