Background: The prolonged boarding of admitted patients in the Emergency Department (ED) increases crowding, a significant challenge for hospitals. To alleviate crowding, some hospitals have implemented hallway boarding, the practice of placing patients in inpatient hallways when standard rooms are unavailable. However, the impact of hallway boarding on patient preferences, clinical outcomes, and patient safety remains uncertain.
Methods: We conducted a systematic review and meta-analysis of studies comparing boarding patients in an inpatient hallway with those in the ED or standard inpatient rooms, examining patient preferences, length of stay (LOS), mortality, or safety outcomes. We used predefined criteria to assess the quality of the studies and calculated pooled estimates of patient preference using random-effects models.
Results: Eleven studies were included, primarily conducted in the United States, with designs ranging from retrospective analyses to surveys of patients, nurses, and physicians. Patient preference was the most studied outcome. Meta-analysis demonstrated that 61% of patients preferred inpatient hallway boarding over ED hallway boarding (95% CI: 50–71%), although heterogeneity was high (I² = 87.4%). Fewer studies reported on clinical outcomes. Inpatient hallway boarding was associated with reduced ED LOS in two studies (13.8 vs 9.3 hours; 6 vs 8 hours) and lower hospital LOS in one. Mortality was unchanged or reduced after hallway policies in three studies. Safety outcomes were mixed, with some evidence of fewer ICU transfers and infections but increased 30-day readmissions in one study
Conclusions: Inpatient hallway boarding respects patients’ preferences, may improve ED throughput, and is unlikely to cause harm. Further high-quality multicenter studies are needed to clarify its impact on patient outcomes and healthcare systems.