The ED can be an uncomfortable, unfamiliar, fast-paced, and disorienting environment for anyone. Hallway care makes it even more so. “The ED hallway can be especially challenging for older adults,” says Liron Sinvani, MD, associate professor of medicine at Zucker School of Medicine at Hofstra/Northwell.
Sinvani and colleagues wanted to find out if the time spent in ED hallways was linked to the development of delirium. “ED delirium has been associated with falls, inappropriate ED disposition, longer hospital length of stay, functional decline, dementia, institutionalization, and higher 30-day and six-month mortality,” notes Sinvani, director of the geriatric hospitalist service at Northwell Health.
Sinvani and colleagues analyzed 25,162 patients, including 1,920 who met delirium criteria.1 Patients with delirium spent a greater percentage of time in the ED hallway than other patients (50.5% vs. 10.8%), and stayed in the ED longer. Patients developed delirium in the ED more often than patients on the inpatient units (77.5% vs. 22.5%). Out of the 1,920 patients who developed delirium, 1,488 did so while in the ED.
“This highlights that the ED is a critical opportunity to prevent, detect, and manage delirium,” Sinvani offers.
ED providers “are under enormous pressure,” according to Sinvani, to simultaneously care for critically ill or injured patients, those boarding in the ED while awaiting an inpatient bed, and manage multiple other clinical duties (including screening for domestic violence and suicide risk).
“However, EDs must prioritize delirium prevention, screening, and management in order to improve the quality of care for millions of older adults presenting to our EDs each year,” Sinvani stresses. The greater percentage of time spent in ED hallways, the more likely it is the patient would develop delirium. “This finding is very important for our older adults presenting to the ED,” Sinvani says. “It should lead to mindfulness to the location of older adults who are waiting for disposition or beds in the ED.”
- van Loveren K, Singla A, Sinvani L, et al. Increased emergency department hallway length of stay is associated with development of delirium. West J Emerg Med 2021;22:726-735.