Hospital Floor Hallway Boarding: A Systematic Review of Outcomes

The prolonged boarding of admitted patients in the emergency department (ED) increases crowding, a significant challenge for hospitals. Some hospitals have implemented hallway boarding by placing patients in inpatient hallways when standard rooms are unavailable. However, the impact of hallway boarding on patient preferences, clinical outcomes, and patient safety remains uncertain.

Systematic review and meta-analysis.

We conducted a systematic review and meta-analysis of studies comparing boarding patients in an inpatient hallway with those in the ED or a standard inpatient room, examining patient preferences, length of stay (LOS), mortality, or safety outcomes. We used predefined criteria to assess study quality and calculated pooled estimates of patient preference using random-effects models.

Eleven studies were included, primarily conducted in the US, with designs ranging from retrospective analyses to surveys of patients, nurses, and physicians. Patient preference was the most studied outcome. Meta-analysis demonstrated that 61% of patients preferred inpatient hallway boarding over ED hallway boarding (95% CI, 50%-71%; P  < .001), although heterogeneity was high ( I² = 87.4%). Fewer studies reported on clinical outcomes. Inpatient hallway boarding was associated with significantly reduced ED LOS in 2 studies (9.3 vs 13.8 hours; 6 vs 8 hours) and hospital LOS in 1. Mortality, as studied in 3 papers, remained unchanged or decreased significantly. Safety outcomes were mixed.

Inpatient hallway boarding can improve ED throughput, and most studies show patients prefer it to ED hallway boarding. No study has shown increased mortality, but current research is insufficient to draw clear conclusions about quality and safety.