Emergency departments (EDs) are currently dealing with big problems of overcrowding and boarding. The number of patients keeps growing, putting more pressure on EDs to find innovative solutions. One approach some EDs try is using hallway beds to handle the overflow. But here’s the thing—it is unknown how this practice impacts patient outcomes and how well the EDs function.

More people are showing up at the ED seeking help for emergencies, social crises, or even routine care. Patients leave without being seen, and those waiting longer often have even worse medical conditions.¹ And it’s not just the patients who suffer—ED staff experience burnout, productivity decreases, errors increase, and costs increase.²

We explored the impact of placing patients in hallways on bread-and-butter ED operations. We looked at things like how long it takes to get a bed, how long it takes to see a clinician, and what happens to the patients downstream. Understanding these factors will help us determine if hallway placement is actually helping or if there are hidden costs.

But let’s not forget the bigger picture. Any care in the hallway is undignified, and ED crowding is a complex issue requiring a comprehensive solution. It’s time for hospital administrators, physicians, policymakers, and everyone involved to come together and find ways to reduce crowding, improve patient flow, and deliver high-quality care.

Our Findings

In a retrospective observational study encompassing two EDs within a larger health system, more than 320,000 patient visits were analyzed. Data were collected on demographics, emergency severity index (ESI), chief complaint, and operational factors. The study’s primary outcomes were door-to-bed time, bed-to-emergency physician, and emergency physician-to-disposition time. The results demonstrated that hallway placement reduced door-to-bed time but significantly increased bed-to-emergency physician time and emergency physician-to-disposition time.

Additional regression analysis found that male patients and patients with Medicaid or self-pay were more likely to be placed in hallways.³ While door-to-bed time decreased, unfortunately, it led to a considerable increase in bed-to-emergency physician and emergency physician-to-disposition time. This resulted in a statistically significant increase in length-of-stay in the ED for patients placed in the hallway. There were no discernible differences in return visits between hallway placement and traditional room assignment.

Hallway use may hasten access to treatment spaces, patients experience prolonged bed-to-emergency physician time and emergency physician-to-disposition times, leading to extended ED stays and potentially impacting outcomes and patient satisfaction. This prompts further investigation into the underlying causes and the development of strategies that optimize patient flow and enhance care delivery.