Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

Introduction: The boarding of admitted patients in the emergency department (ED) is a major causeof crowding and access block. One solution is boarding admitted patients in inpatient ward (W)hallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding.It also assessed their preferred boarding location if they were patients.Methods: A survey administered to a convenience sample of ED and W nurses was performedin a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. Thenurses were asked if there were any circumstances where admitted patients should be boarded inED or W hallways. They were also asked their preferred location if they were admitted as a patient.Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on eachscenario were queried.Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were currentED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46(52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to Wboarding, with 20% of cED versus 83% of current W (cW) nurses (P < 0.0001), and 28% of pEDversus 85% of nurses never having worked in the ED (nED) were opposed (P < 0.001). If admittedas patients themselves, 43 (54%) of all nurses preferred W boarding, with 82% of cED versus33% of cW nurses (P < 0.0001) and 74% of pED versus 34% nED nurses (P = 0.0007). The mostcommonly cited reasons for opposition to hallway boarding were lack of monitoring and patientprivacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existedin all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen,and an intubated, unstable sepsis patient.Conclusion: Inpatient nurses and those who have never worked in the ED are more opposed toinpatient boarding than ED nurses and nurses who have worked previously in the ED. Primarynursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nursesadmitted as patients seemed to prefer not being boarded where they work. ED and inpatient nursesseemed to agree that unstable or potentially unstable patients should remain in the ED but disagreedon where more stable patients should board