Emergency Department Hallway Care From the Millennium to the Pandemic: A Clear and Present Danger

BACKGROUND: Emergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its progression. OBJECTIVES: To discuss reasons for ED crowding leading to hallway care, the impact of the coronavirus disease (COVID-19) pandemic, potential solutions, and why little has changed despite widespread awareness. DISCUSSION: ED crowding has been a public health issue for the past three decades, leading to patient care and boarding of admitted patients in ED hallways with limited resources. This care is often substandard and precarious. The COVID-19 pandemic placed further strain on the ED safety net, especially in certain urban areas. Despite recognition of the problem, publication of studies, and proposals offering many solutions, this problem continues to worsen. Corporate and hospital leadership must be made aware of the financial and legal ramifications for failure to address potential solutions, such as inpatient hallway boarding, provision of flexible expansion care areas, smoothing of elective admissions/surgeries, and efficient inpatient discharge flow. State and federal legislation may also be required to motivate this process. CONCLUSIONS: ED crowding and hallway care will continue to worsen unless hospital leadership is willing to listen to ED staff concerns and address the problem on all levels of the hospital using previously proposed solutions. Emergency physicians should not fear termination for discussing this issue and its potential for poor clinical outcomes and ED staff morale.