Fast for Real or Just a Feel? Reassessing Hallway Treatment Spaces and Their Impact on Emergency Department...

The practice of placing emergency department (ED) patients in hallway treatment spaces, initially a temporary solution to crowding and anecdotally believed to improve the timeliness of care, has become commonplace, raising the need for empirical evaluation of this practice upon established measures of ED throughput.

We conducted an observational study across 2 EDs between July 2017 and February 2020. We classified all visits as receiving hallway care or roomed care. Outcomes include door-to-bed time, bed-to-provider time, provider-to-disposition decision time, door-to-disposition decision time, and ED length of stay (LOS). We analyzed the throughput for discharged and admitted patients using multivariable regression with an instrumental variable, adjusting for demographics and occupancy.

A total of 340,141 ED visits were included, of which 93,289 (27.4%) were initially evaluated and treated in a hallway space. Patients in hallway treatment spaces who were ultimately discharged experienced a 7.57-minute longer overall bed-to-provider time (95% CI, 2.57, 14.14), although they were placed in beds 17.85 minutes faster (20.71, 14.28), with an overall 123.05-minute increase in ED LOS (82.03, 166.81). This relationship between hallway placement and increased LOS was found to be statistically different for certain chief complaints. Admitted patients in hallway treatment spaces also experienced 8.46 minutes faster (5.95, 10.34) door-to-bed time but experienced no significant difference in bed-to-provider, provider-to-disposition decision, and door-to disposition decision times.

Although hallway treatment spaces expedite initial placement, the effects in our ED suggest that they may not improve, and possibly even hinder, overall throughput in EDs similar to ours. Contrary to expectations, these findings suggest that expedited care in hallway spaces could paradoxically hinder operational efficiency and timeliness.