The practice of treating ED patients in hallways has generated some reports in the medical literature expressing concerns for patient safety, though the incidents cited do not reflect a system in which patients are first stabilized and seen by a physician in an exam room.
In one report, a 32-year-old man had been recently diagnosed with type 2 diabetes and sought care at an ED that was 250% over capacity. The initial evaluation, which included a chest radiograph, ECG, and laboratory studies, suggested mild diabetic ketoacidosis.
“His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities, he felt improved and was discharged with arrangements made for outpatient follow-up,” the report says. “Two days later, he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease.”
In the subsequent malpractice lawsuit, the hospital settled for $1 million and blamed the incident on the physician. The state medical board disciplined the doctor, alleging negligence because the ECG had not been personally interpreted by that physician.
“A formal hearing was conducted with the EP’s medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care,” the report says. (That report is available online at: https://bit.ly/2PjI0ib.)
Another report “found that hallway care was associated with worse patient perceptions of clinician-patient communication.” The effects may be worse with acute conditions like heart attacks, in which hallway care may lead to poor communication, which in turn creates more worry and fear in the patient, the study says.
“Recognizing the association between communication and hallway care may identify patients who may benefit from additional psychosocial support and help improve aspects of clinician-patient communication across a wide range of care environments in the ED,” the report says. (That report is available online at: https://bit.ly/2wPaObm.)