Patient flow: Why was my mom parked in the hospital hallway?

QUESTION: My mother was recently in the hospital recovering from surgery. When I arrived to take her home, I found her on a stretcher in the hallway outside of her room.  A nurse said she had to be moved to the hallway to complete her discharge because the room needed to be prepared for the next patient. This seems ridiculous. There’s no privacy in the hallway and, in my opinion, it was demeaning for my elderly mother. What’s the rush?

ANSWER: I understand your concern about your mother’s discharge procedure. There’s no denying that there’s little privacy in the hallway and a lot of patients don’t like being placed there. But, the reality of the situation is that the nurse was right. Every minute delayed in moving one patient out of the hospital means that another patient – possibly a critically ill one – has to wait longer to be treated.

With a growing – and aging – population, hospitals are searching for more efficient ways to safely care for additional patients. The development of minimally-invasive procedures and other medical advances have helped to speed up the recovery process. The average length of time a patient stays in hospital following surgery is much shorter than it used to be.

Still, the logistical challenges are greatest on days when a hospital is operating at near or full capacity. Simply put: you can’t move new patients into a hospital ward if all the beds are already full.

So some hospitals – including Sunnybrook Health Sciences Centre – have adopted the practice of using hallways as temporary holding areas.

“It’s not ideal, but it is one of the measures we use for managing the safe, effective and humane flow of patients through the hospital,” says Dr. Andy Smith, Sunnybrook’s Executive Vice President and Chief Medical Executive.

In recent months, he notes, Sunnybrook has been caring for a very high volume of patients. As a regional centre for the treatment of cancer, burns and trauma, the hospital draws patients from across the province, as well as locally. “Our overall occupancy for the month of June was 101 per cent,” he says. “We are running over capacity.”

In order to manage patient flow, staff has to apply a kind of triage approach to the entire hospital – and, at certain peak times, decide who would be most suitable for a short-term stay in a hallway.

Sunnybrook has about 700 patient beds.

On a typical day at Sunnybrook, about 50 patients are discharged home or transferred to other health-care facilities, says Dr. Smith. Of those patients, only one-in-four leaves before noon.

Yet the morning is often the time of day when the Emergency Department (ED) is dealing with the greatest number of patients.

If these patients are unable to move to the hospital wards because the beds are still occupied, they will have to remain on stretchers in the ED. And if those stretchers fill up, there may be delays in treating newly-arrived patients in the ED waiting room.

It’s not just ED patients who may require beds.  Individuals undergoing scheduled surgeries need beds once they’re out of the operating and recovery rooms.  (A lack of available beds can actually lead to surgery delays and cancellations.)

Late departures can also create other backlogs and bottlenecks. For instance, the bulk of the cleaning staff – that play a critical hygienic role in preparing rooms for incoming patients – start work in the morning. If patients are late leaving their beds, then the rooms can’t be cleaned in a timely fashion – leaving the remaining work to a smaller cleaning staff on a later shift.

“All of this has a domino effect and it means we have people staying in the Emergency Department too long,” says Dr. Smith. “They’re at the most vulnerable part of their patient journey… and they can’t really start their treatment in earnest until they get a bed in a ward.”

So there are compelling reasons why a hospital would want to see as many of the day’s discharges as possible occur in the morning.

And that takes us back to your original query about finding your mother on a hallway stretcher. The step was undoubtedly taken to ease patient flow. Front-line staff would have assessed your mother and concluded she wouldn’t be jeopardized by a move to the hallway prior to discharge.

Other medical experts agree that a patient about to be discharged would fare far better in a hallway than a new arrival in the Emergency Department.

“A patient going home is generally stable, recovered and a better candidate to tolerate a hallway than a recently-admitted patient in an ED hall who, by definition, is too sick to go home right now and has just been through a long and tiring process in the ED,” says Dr. Howard Ovens, director of the Schwartz/Reisman Emergency Centre at Mount Sinai Hospital in Toronto.

Being moved to the hallway may have inconvenienced your mother – and, it’s true, patients like her are making a personal sacrifice. But her early transfer made it possible for a patient in the Emergency Department to receive speedier treatment. Hopefully, she didn’t have to spend too long in the hallway before you took her home.