Is It Safe to Admit Boarder Patients to Inpatient Hallways?
A study at a single academic ED shows that the practice is safe.
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 retrospective cohort study, investigators compared outcomes for patients who were admitted to inpatient hallways with outcomes for patients who were admitted to standard inpatient beds at a single U.S. academic ED between 2004 and 2008. Patients who did not require intensive care unit (ICU) or step-down care or high-intensity nursing care for such needs as continuous suction, high-flow O2, or seizure monitoring were eligible to board in inpatient hallways.
Of 55,062 ED patients who were admitted during the study period, 4% were admitted to an inpatient hallway. ED census at time of triage was significantly higher for patients admitted to hallways compared with patients admitted to standard beds, and time from ED triage to admission was significantly longer for patients admitted to hallways. Approximately 25% of patients admitted to hallways were assigned to a standard bed immediately on arrival to the inpatient unit, 25% were placed in a room within 1 hour, and the remaining 50% waited approximately 8 hours for a room. Patients admitted to hallways, compared with those admitted to standard beds, had significantly lower rates of in-hospital mortality (1.1% vs. 2.6%) and transfer to an ICU (2.5% vs. 6.7%).
Although inpatients in other countries are commonly boarded in inpatient hallways, this practice has met significant resistance in the U.S., with risk to patient safety cited as the major concern. At this study's single institution, boarding selected patients on inpatient units was not associated with risk to patient safety. Other institutions should consider implementing inpatient-unit boarding as part of a multifaceted approach to crowding.
Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine November 20, 2009
Citation(s): Viccellio A et al. The association between transfer of emergency department boarders to inpatient hallways and mortality: A 4-year experience. Ann Emerg Med 2009 Oct; 54:487.