Clinical question: Does inpatient hallway boarding increase in-hospital mortality, 30-day mortality, or 30-day readmission rates?
Background: Prior studies have reported that the boarding of patients in emergency department (ED) hallways when no inpatient beds are available is a major cause of ED crowding and leads to decreased patient satisfaction and adverse clinical outcomes. One way to alleviate ED overcrowding is to enable hallway boarding in the inpatient setting.
Study design: Linear regression analysis based on administrative data from January 2013 to September 2019 to compare in-hospital mortality, 30-day readmission, and 30-day mortality rates of patients hospitalized before and after a 2016 policy change was enacted to allow for inpatient hallway beds.
Setting: Single medical center
Synopsis: The study took place at Shaare Zedek Medical Center, one of the largest hospitals in Jerusalem that averages 7,500 admissions per year. In 2016, due to an increasing number of admissions and subsequent frequent and prolonged periods of ED overcrowding, a new medical center policy to employ inpatient hallway boarding was implemented. Administrative data were collected on 8,583 inpatients before and 11,962 inpatients after this policy change. To minimize differences in the care and treatment of patients, the study focused on two departments with the same leadership over the time of the study. On most days, hallway boarding patients were assigned to an inpatient bed by the end of the same day. After the policy change, there was a notable increase in admissions. The adjusted in-hospital mortality was lower (odds ratio, 0.76; CI, 0.65 to 0.90), 30-day readmission was mildly higher (odds ratio, 1.18; CI, 1.00 to 1.40), and there was no change in 30-day mortality (odds ratio, 1.16; CI, 0.88 to 1.53).
In 2019, a committee for the improvement of treatment in internal medicine departments in Israel published a recommendation that “the practice of inpatient hallway boarding violates patients’ rights for privacy and hampers human dignity.” The committee recommended that such practices be prohibited.
Bottom line: The creation of inpatient hallway beds effectively increased bed capacity, accommodating an increase in patient volume. This was associated with lower in-hospital mortality, increased 30-day readmission, and no change in 30-day mortality.
Citation: Ben Shoham A, Munter G. The association between hallway boarding in internal wards, readmission, and mortality rates: a comparative, retrospective analysis, following a policy change. Isr J Health Policy Res. 2021;10(1):8. doi:10.1186/s13584-021-00443-3.
Dr. Childers is an associate clinical professor at the University of California, San Diego.