Hallway Boarding: An Unnecessary Ethical Dilemma Faced by Hospitals

‘Hallway Boarding’ is a quaint euphemism for parking sick people in hallways until their room is ready.

It used to be done in Emergency Departments when no in-patient beds were available. Now some facilities are “admitting” ED patients to the hallways of inpatient units.

In pain, under stress, wearing gowns open at the rear with a port-a-potty for a bathroom, these patients are the victims of turf wars caused by hospital overcrowding.

The hospitals say they want to relieve pressure in the ED so patients needing urgent care can be treated. But they also admit they want to bring the overcrowding problem to inpatient units. They reason that the patient’s presence forces nurses and others to perform more timely discharges, bed turnovers and admissions.

One U.S. study claims boarding causes no adverse effects, but studies in the United Kingdom say the practice may spread infection. Regardless of which findings one believes, the fact is that transferring this problem to someone else may address the most glaring symptom — an overcrowded ED – but the underlying problem of poorly managed patient flow goes unsolved.

Forget the fact that two wrongs never make a right. The real point is whether it’s ethical to make sick people the “wedge” in an internal battle over who “owns” the overcrowding issue.

This is especially shameful because there are proven ways to fix overcrowding, a hospital-wide problem caused by time lags in the movement of patients. The ED can be decompressed by employing the latest real-time capacity management technologies to squeezing wasted time out of the process and free up as much as 20 percent more bed space per day.

Unless something is done, things will just get worse. Waiting outside the ED doors are 70 million aging baby boomers and the 32 million newly insured under health reform. That’s bad news for hospitals implementing EMRs because two of the most important requirements for reimbursements are tied to Emergency Room performance and quality measure reports.

The American College of Emergency Physicians (ACEP) has made patient boarding a key focus of its advocacy efforts, and the Joint Commission is preparing for revisions to their accreditation standards on patient flow.  Now the Pennsylvania Department of Health has served notice to hospitals in that state that it will closely watch the rise in boarded patients at those hospitals. Other states have or are planning to do the same.

As the company which pioneered the conversion of wasted time into usable space, all we can say is – “it really is about time.”