We all knew hallway boarding was bad for patients. Now we know a little more about why. It has to do with hospital infection.

A study at Brigham and Women’s Hospital showed emergency room caregivers were least likely to practice good hand hygiene when tending to hallway patients. The study, which was the  largest ever focused on ED hand hygiene, supports studies in Ireland which said boarding was another way hospital infection was spread.


Many healthcare professionals consider hallway boarding, either outside of the ED or on unit floors, as the least of several evils.  But perhaps it’s not, based on this study. ED personnel are trained to deal with emergent health problems or the results of accidents and shootings. When they are pulled away to give care to patients who have been stabilized and are waiting for a room, not only is the patient potentially being exposed to infection, but the health worker’s focus is split between the “day” job of emergency medicine and the “part-time” job of attending to patients who now need specialized care. On top of that, someone in the ED isn’t getting the care they need when they need it because of that split.

Patient boarded in hallwayED crowding is the result of an emergency in the rest of the hospital, the one that’s caused by poor capacity management usually due to antiquated manual patient flow processes.

Emergency Departments around the country are to be commended for the fine work they do, including the number of innovative initiatives they’ve undertaken to relieve the pressure on their area. But when ED staff are so squeezed by sheer volume that they feel can’t wash their hands and get their jobs done, they are really being let down by the rest of the hospital.  In particular, those executives who know better ways already exist to improve capacity management, but do nothing about it.

Here’s the link to the Brigham & Women’s study abstract.


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