13 March 2007

More on Hallway Beds

It's a terrible thing, having patients in the hallways. I hate it, the nurses hate it, the hospital administration hates it. And guess what? Patients hate it too. It's kind of like being in limbo, where you may or may not have a nurse assigned to you, and you may or may not see your doctor (or any staff member, depending on which corner you are shuffled off into), and people walk by you constantly without talking to you or making eye contact. It seems like the most common types of patients I see on the hallway gurneys are:

  • Drunks slowly metabolizing their way to freedom (often in 4-point restraints)
  • Psych patients awaiting evaluation (often in 4-points, with security present)
  • Demented geriatric patients awaiting ambulance transfer back to the warehouse nursing home
  • Little old ladies being admitted, waiting for a bed
  • Patients with police needing an "OK to book" exam
  • Three-year-old children with ear infections (who will never be seen if they have to wait for a regular bed)
  • Histrionic Anxiety/Chest Pain patients who came in via 911 but the charge nurse thinks is faking it.
  • Regular folks with moderate orthopedic injuries
I hate it when I have a "regular person" in the hallway. I need to do a lot of things which involve walking up and down the halls and every time I walk past them it's, well, awkward. I don't necessarily have an update or something new to say to them, and I can't exactly inquire how they're doing because I am going somewhere else and don't have the time to really listen to an answer. Yet I feel rude just ignoring them.

A lot of the other folks I am quite content to ignore, especially the drunks.

And of course I feel terrible for the parents of the children who get stuck in the hallway. (invariably close to the most foul-mouthed, abusive smelly drunk we have) Sure, they didn't need to be there, they could have gone to their doc in the morning, but their kid is sick and they got anxious, and their punishment is that they have to explain why that smelly man told the nurse to "go f*ck yourself, b*tch!" Not exactly what I would want for my kid.

Well, once we get the Death Star on line we won't have to deal with that anymore, I hope. For a year or two, until we outgrow the new place.


  1. In general, and not just in the ER, having patients in the hallways is terrible. I've spent a bunch of time in hospitals and it breaks my heart sometimes to see people in such sad states sitting or laying in the hallways waiting for whatever (transport seems to be the common one). People with serious health issues have enough stress in their lives. They don't deserve to suffer the indignity and vulnerability of being stranded and exposed in an open space.

    I'm glad your team is working on a solution for your ER for this problem. These are not little things to the patients and their families. One of the things that pisses me off to no end about hospitals and medical staff is the perpetuation of the idea/feeling that you have no control of your medical care or quality of experience. There is this continuing mystique around the infallibility and superiority of doctors and their opinions. And also the pervasive attitude that patients have no say in when and where procedures happen, when and where they are allowed to go, and etc. Its mostly a bunch of BS and doctors and staff, in my experience, are just fine with the status quo and doing what they can to maintain the myth because it makes things easier for them.

    Sorry. I got a bit of my rant on there. I was tempted to keep going, but I've already gone far off topic.

  2. I had to be in a hallway bed in the ER one Saturday night before they opened the new ER, because I was covered in blood from head to toes, quite literally, so they wisely decided the waiting room was not the place for me. Oh and the inside of my wrist was hanging out of my arm and I was holding them in with a towel. It wasn't a completely horrible experience but I would have much preferred being in a room where people couldn't stare at me and ask me what had happened over and over again. Then I had to tell them I had gotten bit by my brother's pit bull because another dog in the house much smaller than him bit him twice so I grabbed him and every time the other dog bit him he snapped and got me. Not really a story I wanted to keep telling especially because the injury to my hand was bad enough that I eventually had to have surgery on it.

  3. We keep our hallway beds in the triage area, therefore the docs don't have to keep walking by them averting our eyes. If they aren't in a room, we don't have nursing staff to do anything for them anyway. The only reason they're in a bed at all is if they are too sick to sit in a chair.

    Technically, it would be better to swap out some of the pending admissions for "hallway bed" patients, but that would make even more work for the nurses, so that idea usually doesn't go over too well. Besides, sometimes the pending ICU admits, for example, still need stuff done and still need a nurse.

    There aren't any easy answers, but moving pending admits to the floor hallways would be a great start.

  4. Scalpel,

    We threated to do just that -- send admitted patients to the floor hallways, supported by a recent JCAHO standard regarding Ed boarding. That threat, not surprisingly, got hospital administration in gear and they have developed some really innovative programs to move patients smoothly upstairs. Also, they opened some more beds. So we are lucky just now that we board admitted patients infrequenly, and even then not for too long.

    Unfortunately, the patients just keep coming in, so hallway beds they get.

  5. The problem we have is that often, the pending admits need monitoring... and the monitors are in the rooms. We can "board" people in the hallways only if they're waiting on a regular floor bed, and at our hospital, we usually have enough of those. It's the ICUs that are short.

    It's not only docs who have the dilemma you describe. I've developed a little "eye contact and nod" maneuver, which I can do without slowing down. I hope it lets people know we haven't forgotten about them, but don't have time to just chat. Anyway, unless I know who they are and why they're in the hall, I don't even know if it's safe to get them a cup of ice water.

  6. I hate to be the bearer of bad news but I will put money down and bet ya anything, Shadow, that even with the new Death Star, sooner or later, you folks will be using hallway beds there as well.

    Where I'm at, our ED is a new facility. Yeah, we had a major expansion, 40 total monitor beds, 10 Fast Track rooms, 1 ENT/Eye room, 4 major resuscitation/Trauma Bay, 4 lock down psych rooms, 4 Gyn rooms, 4 Pediatric rooms. We even added an 8 bed Observation Unit. Our census doubled in a course of 2 1/2 years. Not even a year moving into our new Death Star, we had to use the hallway all over again and boarding admitted patients and taking EAU overflows in our Observation Unit.

    You and I both know that the overcrowding of our EDs is just reflection of our national health care crisis. As long as the number of our uninsured popululation keeps on climbing, as long as less and less specialists agree to take unattached ER calls, as long as EMTALA continues to be an unfunded mandate, as long as...the list is too damn long...As long as our national health care crisis persist, there will always be patients in our ED hallways, no matter how big of a Death Star you build


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