1. Enhance resource allocation: Allocate sufficient resources, including staff, treatment spaces, and equipment, to meet the increasing demand in the ED. Implement effective triage systems to prioritize patients based on acuity and optimize the utilization of available resources.
2. Data-driven decision making: Leverage data analytics to identify patterns, bottlenecks, and areas for improvement within the ED. Regularly evaluate key performance indicators and employ evidence-based strategies to drive decision-making and quality improvement initiatives.
3. Redesign front-end flow: Consider implementing triage practices or standardized order sets for patients who are more likely placed in a hallway bed.
4. Staff support and well-being: Recognize the immense pressure ED staff face due to overcrowding and hallway care. Provide support mechanisms, such as sufficient breaks, access to mental health resources, and regular debriefing sessions, to mitigate burnout and promote staff well-being.

Hospital leaders must urgently address the burden of ED crowding and its effects on hallway care. They can create a more efficient and patient-centered emergency department by implementing strategic measures to enhance resource allocation, prioritize staff well-being, and embrace data-driven decision-making. Let‘s take action to optimize care delivery, support physicians, and improve patient outcomes.

Acknowledgment

Thank you to Arjun Venkatesh, Andrew Ulrich, Vivek Parwani, Reinier Van Tonder, Edieal Pinker, Beth Liebhardt for their support of this work and commitment to improving care of patients in the emergency department.

Mr. Su is a PhD candidate in Operations Management with a research interest in optimizing healthcare operations to enhance efficiency, fairness, and patient outcomes.

Ms. Meng is an assistant professor of operations management at the Yale School of Management at Yale University.

Dr. Sangal is an associate medical director of the Yale Adult ED and assistant professor of emergency medicine at Yale University.

Dr. Dilip is a second-year healthcare administration and leadership fellow at Yale University and completed her residency at Kings County/SUNY Downstate in Brooklyn, NY.

References

1. Feldman JA. When the aberrant becomes the accepted: The rise of hallway care in emergency medicine. Acad Emerg Med. 2020;27(3):256-258.
2. Bernstein SL, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1-10.
3. Feiz A, Baker W. Limits of capacity flexibility: Impact of hallway placement on patient flow and quality of care in the emergency department. Social Science Research network website. Published October 22, 2021. Accessed November 28, 2023.
4. Janke AT, Melnick ER, Venkatesh AK. Hospital occupancy and emergency department boarding during the COVID-19 pandemic. JAMA Netw Open. 2022;5(9);e2233964.