The following is a summary of “Inequities among patient placement in emergency department hallway treatment spaces,” published in the February 2024 issue of Emergency Medicine by Tuffuor, et al.

In the emergency department (ED), capacity issues like boarding and crowding have led to patients receiving care in hallways to ensure timely evaluation and treatment. However, concerns have been raised about the impact of hallway care on patient-centered care and quality. For a study, researchers sought to explore social risk factors associated with hallway placement and operational outcomes in the ED.

The observational study between July 2017 and February 2020 examined data from 361,377 ED visits. The primary outcome was the adjusted odds ratio (aOR) of patient placement in a hallway treatment space, adjusting for patient demographics and ED operational factors. Secondary outcomes included left without being seen (LWBS), discharge against medical advice (AMA), elopement, 72-hour ED revisit, 10-day ED revisit, and escalation of care during boarding.

Of all ED visits, 27.7% (100,079) were assigned to hallway beds. Patients with Medicaid (aOR 1.04, 95% CI 1.01,1.06) or self-pay/other insurance (1.08, (1.03, 1.13)), and male patients (1.08, (1.06, 1.10)) had higher odds of hallway placement compared to those with private insurance. However, patient age, race, and language were not associated with hallway placement. Adjusting for ED census, triage assigned severity, staffing, boarding level, and time effect, patients placed in hallways had higher odds of elopement (1.23 (1.07,1.41)), 72-hour ED revisit (1.33 (1.08, 1.64)), and 10-day ED revisit (1.23 (1.11, 1.36)) compared to those in regular ED rooms. There were no significant associations between hallway placement and LWBS, discharge AMA, or escalation of care.

Hallway usage in the ED was associated with consistent differences in care delivery, with patients insured by Medicaid, self-pay, or male sex more likely to be placed in hallway beds. Future research should investigate how new front-end processes, like provider in triage or split flow, may equitably affect patient access to emergency and hospital care.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006174