Use of Hallway Beds to Reduce Overcrowding of Admitted Patients

This position statement was archived on 11/7/2012. AMSN prefers to endorse the position statement of the Emergency Nurses Association (ENA) of Holding Patients in the Emergency Department.

IT IS THE POSITION OF AMSN THAT:

  • From the point of entry into the hospital system, all patients must receive the appropriate level of care based on their assessed needs and provided by practitioners who have established competency in addressing patients'' identified problems.
  • Provision of quality care within an organization requires use of an appropriate skill mix and staffing numbers based on patient needs and specific to the level of care.
  • The practice of admitting patients to hallway beds while they await appropriate room assignments is patently unsafe and should never be used.
  • Strategies to eliminate artificial variability in patient census and inefficiencies at the system level should be developed to improve the throughput of patients within the hospital.

OVERVIEW:

The practice of admitting patients to hallway beds has been used as means to improve throughput in Emergency Departments. However, the negative impact of this practice on patients and inpatient nursing staff must not be ignored. Merely shifting the burden of care to the inpatient unit creates an artificial improvement in patient flow in one area but disrupts care provision in another. As inpatient nurses are expected to accept responsibility for the additional patients in hallway beds, safe staffing numbers are disrupted. Actions which disrupt appropriate staffing levels in any patient care area within the organization contribute to suboptimal patient outcomes and patient dissatisfaction, leading to greatly reduced quality of care.

Patients must be provided adequate space, privacy, comfort, and safety at all times. Hallway beds do not provide clinicians with bedside access to equipment, such as oxygen, suction, and call lights, needed for safe provision of care. Patients are at greater risk for falls and other adverse events if they cannot access a call light or be monitored appropriately by nurses.

RATIONALE:

AMSN supports multidisciplinary and interdepartmental cooperation within an organization to develop strategies that enhance and improve safe patient flow throughout the hospital and lead to placement of the patient in the appropriate inpatient bed.

REFERENCES:

Academy of Medical-Surgical Nurses. (2008). Staffing standards for patient care. Retrieved August 25, 2008, http://www.amsn.org/cgi-bin/WebObjects/AMSNMain.woa/1/wa/viewSection?tName=positionsStaffingStandardsForPatientCare&s_id=1073744079&ss_id=536873229

Emergency Nurses Association. (2006). Holding patients in the Emergency Department. Retrieved October 12, 2009, from http://www.ena.org/SiteCollectionDocuments/Position%20Statements/ Holding_Patients__in_the_Emergency_Department_-_ENA_White_Paper.pdf

Massachusetts Nurses Association. (2005). MNA position statement opposing DPH policy allowing boarding and care of patients in the corridors of inpatient units. Retrieved October 12, 2009, from http://www.massnurses.org/nursing-resources/position-statements/hall-patients