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Emergency Department Hallway Care From the Millennium to the Pandemic: A Clear and Present Danger
John R Richards1, Robert W Derlet1
1Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California.
Insights
Emergency department (ED) crowding and hallway care persist as critical issues despite decades of awareness. Hospital leadership must implement solutions to improve patient care and ED staff morale, preventing further deterioration.
Area of Science:
- Public Health
- Healthcare Management
- Emergency Medicine
Background:
- Emergency department (ED) crowding and hallway care have been persistent problems in the United States and globally for over 30 years.
- Numerous studies and proposed solutions have failed to significantly impact the progression of ED crowding and its associated challenges.
Purpose of the Study:
- To explore the underlying reasons for emergency department crowding and hallway care.
- To examine the impact of the coronavirus disease (COVID-19) pandemic on ED crowding.
- To discuss potential solutions and analyze the lack of progress despite widespread awareness.
Main Methods:
- Literature review and analysis of existing studies on ED crowding.
- Discussion of the impact of the COVID-19 pandemic on emergency care.
- Exploration of proposed solutions and reasons for their limited success.
Main Results:
- ED crowding leads to substandard patient care and boarding in hallways, exacerbated by the COVID-19 pandemic.
- Despite extensive research and proposed interventions, the problem of ED crowding continues to worsen.
- Financial and legal ramifications for hospital leadership are significant if solutions are not implemented.
Conclusions:
- ED crowding and hallway care will escalate without decisive action from hospital leadership.
- Implementation of previously proposed solutions, addressing issues like inpatient boarding and discharge flow, is crucial.
- Open communication from emergency physicians regarding ED crowding and its consequences is essential, without fear of reprisal.
Background:
Emergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its progression.
Objectives:
To discuss reasons for ED crowding leading to hallway care, the impact of the coronavirus disease (COVID-19) pandemic, potential solutions, and why little has changed despite widespread awareness.
Discussion:
ED crowding has been a public health issue for the past three decades, leading to patient care and boarding of admitted patients in ED hallways with limited resources. This care is often substandard and precarious. The COVID-19 pandemic placed further strain on the ED safety net, especially in certain urban areas. Despite recognition of the problem, publication of studies, and proposals offering many solutions, this problem continues to worsen. Corporate and hospital leadership must be made aware of the financial and legal ramifications for failure to address potential solutions, such as inpatient hallway boarding, provision of flexible expansion care areas, smoothing of elective admissions/surgeries, and efficient inpatient discharge flow. State and federal legislation may also be required to motivate this process.
Conclusions:
ED crowding and hallway care will continue to worsen unless hospital leadership is willing to listen to ED staff concerns and address the problem on all levels of the hospital using previously proposed solutions. Emergency physicians should not fear termination for discussing this issue and its potential for poor clinical outcomes and ED staff morale.
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