Adoption of Boarding in Inpatient Hallways During Emergency Department Crowding

Emergency department (ED) boarding is a critical threat to patient safety. ED leaders consider inpatient hallway boarding-moving admitted patients from the ED to inpatient unit corridors while awaiting inpatient beds-a best-practice countermeasure. However, the extent of inpatient hallway boarding usage in practice is unknown. Our objective was to survey hospitals to characterize the adoption and implementation of inpatient hallway boarding.

We designed, piloted, and administered an online survey addressing inpatient hallway boarding adoption and implementation to all members of the American Hospital Association's Hospital Capacity Management Consortium, representing capacity leaders from 91 hospitals in 34 states. We assessed adoption by the proportion of respondents reporting inpatient hallway boarding usage within the last 12 months. We assessed implementation by the number of boarding patients moved from the ED to inpatient hallway spaces.

The response rate was 80.2% (73/91). Thirty-one of 73 (42.5%) respondents reported using inpatient hallway boarding during the last 12 months. Of these, 15 tracked inpatient hallway boarding patient volumes. The median reported number of patients moved from the ED to inpatient hallway spaces was <1 patient per day (mean=1.5, SD=1.9). The median ED boarding census (respondent-reported number of boarding patients in the ED at midnight each day, averaged over the year) for these hospitals was 40 (mean=41, SD=16). Respondents from 5 states reported their state health departments restricted inpatient hallway boarding usage.

Although inpatient hallway boarding is an evidence-based countermeasure to ED boarding, only a minority of surveyed hospitals adopted inpatient hallway boarding. Among hospitals adopting inpatient hallway boarding, the number of patients moved from the ED to inpatient hallways was minimal.