Transfer of Emergency Department Boarders to Inpatient Hallways and Outcomes of Oncology Patients' Increased Satisfaction
Sunnybrook Health Sciences Centre, University of Toronto
Harsh Naik (research assistant)
At Sunnybrook, a policy implemented to ease ED crowding by moving admitted patients into hallway beds or off-service beds. A policy of hallway admission does not appear to compromise patient care in terms of medical assessment and investigations. However, the Hallway policy did not reduce the patient length of stay in the Emergency Department. Nursing care may be delayed to patients admitted to the hallway and patient satisfaction was decreased among hallway patients. Increased length of stay was seen to be related to hospital occupancy rates. Hallway patients were a function of % occupancy, not ED volumes or overcrowding coefficients. There were delays in hallways admission as well as patient dissatisfaction with utilizing a hallway care policy. It is unclear if this policy is beneficial to patient care or to hospital inpatient pressures. Next steps should be to find a solution to reduce hospital occupancy to minimize the use of a hallway admissions policy.
Emergency department (ED) crowding is an important issue in the delivery of high-quality medical care. A policy was implemented to ease ED crowding by moving suitable admitted patients into inpatient hallway beds or off-service beds. This study assesses the impact of off service and hallway bed admissions on patient care and satisfaction. Retrospective and prospective data were collected from Jan 1 to Dec 31, 2011, on admissions to the oncology service via the ED. Patient care data was collected as follows: chest/abdominal exams performed at first MD visit, number of MD visits within 48 hours, time to antibiotic administration, time to complete vitals, and mean time spent in the ED. One hundred and eighteen patients were admitted to a hallway bed (HALL). A random sample of 90 patients were used for comparison in the on service (ON) and off service (OFF) groups. Among HALL patients, 4% percent discharged themselves against medical advice (0% of OFF and ON patients). MD visits within 48 hours were the same among all groups (mean=6). Time to first completion of vitals was 1:05 (hh:mm) for HALL patients (1:21 and 00:34 for OFF and ON patients, respectively). Time to antibiotic administration was 15:34 for hallway patients (23:59 and 12:35 for OFF and ON patients, respectively). More HALL patients expressed dissatisfaction with their hospital stay (16.7%) compared to OFF (0%) and ON patients (0%). Mean time for admitted patients in the ED awaiting their HALL bed was 9:14, considerably longer than for OFF patients (3:08) and ON patients (4:19).Admission of oncology patients in hallway or in offservice beds did not appear to compromise the timeliness or frequency of medical assessments. Moreover, the policy did not meet its intent to reduce patient time spent in the ED.