Possible Reasons Why

1. Our systems are overwhelmed: As previous studies have demonstrated, running our emergency system at capacity levels higher than 85-90 percent results in resources becoming overwhelmed and, as a result, increased boarding and hallway utilization.⁴ This ultimately leads to medical errors and threats to patient safety and privacy.
2. Implicit biases in health care: The disparities observed in the study, with males and patients on Medicaid or self-pay insurance being more likely to be placed in hallway beds, could be attributed to inherent biases within the health care system. Unconscious stereotypes or assumptions about specific patient populations can influence decision making, leading to differential treatment and bed assignment.
3. Barriers to accessing primary medical care: Limited access to timely primary care services may result in higher ED visits for lower acuity complaints. When these patients present to the ED, their lower acuity level may influence decisions regarding bed placement, making hallway beds suitable for less urgent cases.
4. Limited access to resources and monitoring equipment: Hallway beds often lack the equipment and resources that dedicated treatment spaces provide. This can lead to delays in providing specific procedures, pelvic exams, ensuring privacy, access to oxygen, suction, and other essential care.
5. Transient residents waiting for space: Junior or rotating residents sometimes may wait for a dedicated treatment area to take medical histories or perform procedures or interventions. This inadvertently prolongs the stay of patients in the hallway, unaware that their history or procedure can be conducted in the hallway itself.
6. Limited privacy and patient discomfort: The lack of privacy in hallway spaces can make patients feel uncomfortable and self-conscious. Patients may also find it harder to focus on their care because of the commotion and activity around them. Discussing sensitive medical information may become challenging, affecting the patient’s overall experience and future willingness to seek care. Ideally, any sensitive chief complaint should result in a private exam space for evaluation.

Hallway placement poses significant challenges and potential drawbacks. It’s crucial for hospital administrators and policymakers to challenge the common mantras that justify this practice. Instead, they should work toward finding comprehensive solutions prioritizing patient safety, privacy, and efficient care delivery. By addressing these issues head-on, we can strive for an ED environment that genuinely prioritizes the well-being and needs of every patient.

Possible Steps for Administration

Given the detrimental effects of hallway placement on ED efficiency and patient care, hospital administrators must take proactive measures to combat crowding. We recognize, of course, that much of ED crowding stems from increased hospital boarding, which ED leaders can’t solve. In the interim, we recommend the following steps: