Emergency department overcrowding: Patient preference for boarding hallway location

Study objectives: An unfortunate nationwide hospital patient flow epidemic exists. Emergency department (ED) outflow of admitted patients awaiting inpatient ward room placement contributes to this problem. One solution recognized in New York that was withdrawn from the Jointre Organizations (JCAHO) 2004 Hospital Accreditation Manual (draft version) was for admitted patients to wait outside the ED. We wish to learn what location patients prefer. Methods: A convenience sample of patients from the ED and inpatient ward in a tertiary urban center completed a survey differentiating boarding location preference, the degree they objected to boarding in each location, and rationale for their preference. None of the patients were actually in the hallway at the survey. The study was conducted from January to March 2004 after an institutional review board–expedited review. Results: Three hundred thirty-seven (96%) of 352 patients surveyed voiced a boarding location preference. Two hundred twenty-three (66.2%) patients preferred boarding in the inpatient ward hallway versus 114 (33.8%) in the ED. Two hundred sixty-four (75.9%) patients were surveyed on the ward and 88 (25%) in the ED. Boarding location preference was not affected by interview site. Less than a Commission on Accreditation of Healthca1.8% absolute difference existed across sites for ward and ED hallway preferences. A rationale for hallway preference was supplied by 146 (65.5%) who favored boarding in the ward and 80 (70.2%) who favored the ED. Of those preferring the ward, 74 (50.7%) patients desired to avoid the ED's high level of traffic, noise, commotion, or low level of privacy. Forty-three (29.5%) patients cited physical proximity to their room, to "get in faster," or "see your room." Seventeen (11.6%) pro-ward hallway patients' justification could be grouped under a common category characterized by feeling uncomfortable in the ED because it was "too dangerous" or "rough," made them nervous, had more germs or weird people, and had less cosmetic appeal. Of the patients opting for boarding in the ED, 46 (57.5%) patients justified their decision by reporting that health care and treatment would be quicker or better or involve physicians. Fourteen (17.5%) patients thought that the ED was more comfortable, safer, private, and spacious, with less traffic and fewer people to "look at me funny." The next most common justification was by 5 (6.3%) patients who believed they would reach their room in less time. When asked to choose their degree of objection, those desiring boarding in the ward and ED chose "no problem" (27.4 versus 21.9%), "minor inconvenience" (30.9% versus 31.6%), "dissatisfied" (23.4% versus 26.3%), "very dissatisfied but understand" (7.2% versus 7.9%), "very dissatisfied and angry" (10.8% versus 9.6%), or had no answer (0.4% versus 2.7%). Conclusion: Nearly twice as many patients would prefer to be boarded in an inpatient hallway in contrast to the ED hallway. In suboptimal situations when there is no other care location than the hallway, administrators and the JCAHO should also consider the admitted patient's preference. Patients in our hospital were surprisingly forgiving of the potential of being placed in the hallway.