Abstract and Introduction
Abstract
Background Boarding of admitted patients in the emergency department (ED) is a major cause of crowding. One alternative to boarding in the ED, a full-capacity protocol where boarded patients are redeployed to inpatient units, can reduce crowding and improve overall flow.
Objective Our aim was to compare patient satisfaction with boarding in the ED vs. inpatient hallways.
Methods We performed a structured telephone survey regarding patient experiences and preferences for boarding among admitted ED patients who experienced boarding in the ED hallway and then were subsequently transferred to inpatient hallways. Demographic and clinical characteristics, as well as patient preferences, including items related to patient comfort and safety using a 5-point scale, were recorded and descriptive statistics were used to summarize the data.
Results Of 110 patients contacted, 105 consented to participate. Mean age was 57 ± 16 years and 52% were female. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. The overall preferred location after admission was the inpatient hallway in 85% (95% confidence interval 75–90) of respondents. In comparing ED vs. inpatient hallway boarding, the following percentages of respondents preferred inpatient boarding with regard to the following 8 items: rest, 85%; safety, 83%; confidentiality, 82%; treatment, 78%; comfort, 79%; quiet, 84%; staff availability, 84%; and privacy, 84%. For no item was there a preference for boarding in the ED.
Conclusions Patients overwhelmingly preferred the inpatient hallway rather than the ED hallway when admitted to the hospital.
Introduction
Lack of hospital capacity and crowding in the emergency department (ED) is a well-recognized problem and has been a major threat to public health over the past 20 years. ED and hospital crowding are associated with ambulance diversion, patient walkouts, delays in care, medical error, and higher mortality rates.
Various strategies have been suggested to ameliorate ED and hospital crowding. Driven by lack of hospital capacity, solutions lie beyond the ED and must involve the entire institution. One such solution is the full-capacity protocol (FCP). In times of boarding of admitted patients in the ED due to lack of inpatient beds, patients are redeployed to hallways of inpatient units while awaiting a regular hospital bed. At the authors' institution, no more than two patients are placed on any given inpatient unit. Such patients, although not in a room, are directly receiving care from the appropriate inpatient physician and nurse specialist.
Earlier studies have shown that using such a protocol is associated with decreased waiting times in the ED, decreased ambulance diversion, and overall decreased hospital length of stay (16). A major potential barrier to implementing an FCP is the concern that it would reduce patient satisfaction. There is a paucity of patient satisfaction data on hospital-wide measures designed to alleviate ED crowding. Pines et al. noted an association between prolonged ED boarding times and lower ED and overall hospitalization satisfaction scores. Although prior studies have evaluated what patients believe they would prefer if given a choice, this is the first study of patients who actually experienced both ED and inpatient boarding.
We examined patient preference for and satisfaction with admission to ED or inpatient hallways due to crowding. We hypothesized that most patients would prefer to board on inpatient hallways rather than the hallway in the ED.