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1.1 Background
As problems with boarding and crowding rise in emergency departments (EDs), patients are being pushed out of traditional care areas, and an increasing number are cared for in hallway beds [1]. Overcrowding has been recognized as an international problem in emergency medicine [2]. Despite the growing number of hallway patients (HPs), there is limited research into the effects of hallway care location on patient outcomes.
The existing data about HPs creates concern regarding this specific population. Compared to patients in standard treatment rooms, HPs report lower overall satisfaction scores and lower satisfaction based specifically on their treatment area [3]. In an era of satisfaction scores impacting physician and hospital reimbursement, this is an important issue. Patients have also repeatedly demonstrated a preference for boarding in inpatient hallway beds as compared to boarding in ED hallways [4,5]. Despite the increased use of hallway beds to provide care in EDs, there is limited research about whether this affects patient care or is associated with adverse outcomes.
1.2 ImportanceSurvey studies and observational research studies have suggested that hallway care could be a threat to patient safety. In a survey of 60 Norwegian hospitals, the head physicians and head nurses agree with statements that caring for patients in corridors reduces the quality of care, increases the risk of mistakes and accidents, increases the risk of infections, and decreases the amount of time spent by providers with patients [6]. Healthcare provider hand hygiene use decreases at peak times of overcrowding and the decrease in hand hygiene is magnified for patients cared for in hallways [7]. Patients cared for in hallway beds report feeling avoided and unseen by health care professionals [8]. The mean time to initial patient evaluation by a provider is longer for someone triaged to a hallway bed [9]. Finally, case reports have indicated that there is an increased risk of malpractice for patients treated in hallways [10].
1.3 Goals of this investigationThis preliminary investigation aimed to examine whether there was any association between hallway care and 30 day adverse outcomes for ED return visit, inpatient readmission, observation readmission, and mortality.
2 Methods