This year’s top article selections from Annals Editor in Chief Dr. Yealy cover areas encountered in the daily routines of emergency physicians and explore clinical topics critical for patient care. Commenting on one  article about boarding, Dr. Yealy noted, “We’ve talked about inpatient hallway boarding for years. Yet, it always seems like something that can’t be done, even when inpatients are boarding in hallway stretchers and chairs in the ED.” Turning his attention to the selected article about the risk of persistent opioid use, Dr. Yealy described it as “a fascinating preliminary look on a key topic — important given the attention and lore about longer term opioid misuse.” Read more about these and other articles in Annal’s top picks for the year.

Adoption of Boarding in Inpatient Hallways During Emergency Department Crowding

Discussed for 20 years as one tool to manage hospital capacity demands, sharing hallway patient boarding with inpatient units helps instead of  exclusively using ED-hallway positioning while awaiting a room. To assess current inpatient shared hallway boarding practices, these authors surveyed hospital capacity leaders in 34 states and 91 sites. The responses suggest inpatient hallway use is still markedly dwarfed by ED hallway use despite much opportunity. Inpatient hallways are not the answer to bed delays, but using only ED hallways at peak demand times remains common for many reasons, real and perceived, despite clear harms. Finding alternative approaches to ED hallway boarding will require new strategies and engagement with both hospital teams and regulatory leaders.¹

Effect of Routine Opt-Out HIV Screening on Emergency Department Operational Metrics: Results From the Pragmatic Randomized HIV TESTED Trial

The ED can be a powerful site to detect illnesses and health risks beyond focusing on presenting acute concerns. This opportunity must be balanced with resources, needs, and missions. HIV screening is often offered to ED patients, but this results in limited use. These authors assessed the impact of three triage based “opt-out” HIV screening approaches in nearly 40,000 ED patients, in contrast to traditional “opt-in” methods. Of all who could be tested, 44 percentdid not opt out, enhancing screening numbers. The new approaches were associated with very small increases in some time-based care intervals and leaving before treatment completion. These observations show that  ED HIV screening can add to testing capacity with a small operational burden.This may be a model for other screening.²

A Prospective Cohort Study to Determine Which Opioid-Naïve Emergency Department Patients Are at Risk of Persistent Opioid Use