The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

Abstract

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.