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Providing Care in Emergency Department Hallways: Demands, Dangers, and Deaths

DOI: 10.1155/2014/495219

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Abstract:

Emergency departments (ED) worldwide have experienced dramatic increases in crowding over the past 20 years that now have reached critical levels. One consequence of ED crowding has been the routine use of ED hallways for patient care. This includes ED patients who are awaiting care but are considered unstable to remain in the waiting room, patients who are undergoing active medical and trauma treatment, and patients who have been stabilized but await transfer to an inpatient bed (boarding) or another institution. Compared with licensed hospital or standard ED beds, care in ED hallways results in increased patient morbidity and mortality, as well as patient and staff dissatisfaction. Complications experienced by hallway patients include unrecognized sudden respiratory arrest or unstable cardiac arrhythmias, delay in time-sensitive procedures and laboratory testing, delay in receiving important medications, excessive or unrelieved pain, overall increased length of stay, increased disability, and exposure to traumatic psychological events. While much has been published on the general problems of ED crowding, only recently have studies focused exclusively on the issues of providing care in ED hallways. This review summarizes the current issues, challenges, and solutions for hallway care. 1. Introduction Prior to the 1990s providing care in emergency department (ED) hallways was uncommon, occurring only periodically for short segments of time [1, 2]. Influx of patients generally matched a corresponding outflow, either by discharge home or admission to inpatient units. In some EDs, empty beds were reserved to ensure adequate surge capacity for a sudden influx of patients. In the 1990s, crowding first became a concern in inner city and teaching hospital EDs [3, 4]. Over the next decade the majority of suburban and rural EDs would also experience crowded conditions [5, 6]. As crowding increased, the inflow of patients exceeded outflow for extended hours each day, resulting in the need to place patients somewhere [7]. For a growing number of EDs the solution was to move both stable and semistable patients from licensed ED beds into adjacent ED hallways, thus freeing up the official ED bed for another patient [8]. In these circumstances ED physicians face a difficult challenge. They must provide care to patients in the hallway with suboptimal nursing support and lack of privacy, which precludes a full history and physical examination. Patients may not be able to be fully monitored. Returning new patients back to the waiting room until a licensed ED bed becomes

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