Direct Bedding in the Emergency Department: A Concept Analysis

Direct bedding is implemented widely in United States emergency departments to mitigate overcrowding. However, a formal conceptual definition has not yet been established, limiting consistent interpretation and evaluation across settings. This study aimed to synthesize and evaluate literature featuring ED direct bedding to describe the associated attributes, antecedents, and consequences to generate the first conceptual definition.

We comprehensively searched publications (N = 1622) from PubMed, CINAHL, Embase, and Scopus using the key words "((direct) OR (immediate)) AND bedding," including empirical studies and relevant gray literature with no restrictions on year, country, or language. Using Rodgers' evolutionary method, we extracted and synthesized definitions and descriptive elements of direct bedding, including attributes, antecedents, consequences, and surrogate terminology. Data were analyzed using thematic synthesis to identify conceptual patterns. Nursing services delivery theory was used to instill direct bedding as a throughput-level model of care within an input-throughput-output system.

Our search yielded 22 publications. No formal concept analysis was found. Rodger's evolutionary method guided our analysis because it emphasizes the dynamic and context-dependent nature of concepts. After analyzing overarching attributes, we describe direct as a dynamic operational strategy where patients are placed directly into ED treatment spaces to undergo simultaneous multidisciplinary assessment and care; it is an alternative to a traditional triage process. Identified antecedents included patient volumes, treatment space availability, institutional policy, and multidisciplinary team buy-in.

Consequences include improvements in time-based ED operational performance (eg, reduced door-to-provider time, ED length of stay, and left without being seen rates), increased patient satisfaction, changes in resource utilization, and mistriage.