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Inequities in Hallway Bed Placement

March 21, 2024

Written by Doug Wallace

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In the absence of a standardized approach, patients placed in hallway beds were more likely to be male, have Medicaid/self-pay payer status, and elope in this single health system study.

Hallway beds are less than ideal
Nationwide, ED visits have steadily increased over the past decade, without a requisite increase in hospital capacity, resulting in ED crowding becoming a reality across the country. Hallway treatment spaces are one strategy many health systems have implemented in response.

The authors designed a retrospective observational study of visits between July 2017 and February 2020 across two urban EDs, one academic and one community. Data was harvested from the EMR (Epic) and analyzed with a multivariable logistic regression model, adjusting for patient demographics including sex, age, race, ethnicity, payer status, and ED crowding metrics.      

27.7% of visits were assigned to a hallway bed during the study timeframe in an ad hoc fashion by varying staff members. The primary outcome was odds of hallway placement. Secondary outcomes included LWBS, AMA, elopement, escalation of care, and ED revisits. Elopement rates, male sex, Medicaid insurance, and self-pay status were found to be associated with hallway bed assignment. Age, race, ethnicity, language, escalation of care, and leaving AMA rates were notably not associated with hallway placement.

The authors call for more investigation into this topic and dedicated efforts to minimize deleterious effects of hallway bed placement as well as bias in bed assignment. They suggest standardization of departmental policy on bed assignment as one potential solution.

How will this change my practice?
I think we all know hallway beds are less than ideal for patients and providers. They are an imperfect solution to the ever increasing challenges of ED crowding. Paraphrasing the question I often hear posed: “What is worse, a hallway bed, or sitting in the waiting room?”

This study reminds me of the potential for inequity in any operational approach and the importance of retrospective analysis. I would be interested to know how acuity and complexity of presenting complaints contributed to hallway bed assignment. Going forward, I will advocate for standardization to reduce the possibility of inequity in bed assignment within my own system.

Inequities among patient placement in emergency department hallway treatment spaces. Am J Emerg Med. 2024 Feb;76:70-74. doi: 10.1016/j.ajem.2023.11.013. Epub 2023 Nov 11.

What are your thoughts?