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Inpatient bedspacing: could a common response to hospital crowding cause increased patient mortality?

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Emergency department (ED) overcrowding results in patient and provider dissatisfaction, poorer quality of care, increased healthcare costs, and even increased mortality in some studies.1–4 In response to this evidence, many hospitals have instituted full capacity protocols in which patients in the ED who are admitted but waiting for a bed on the home ward of the admitting service are sent to the first available inpatient bed (or even inpatient hallway) even if it is off-service—a practice known in the UK as boarding or medical outliers,5 6 and in other countries as bedspacing.

Why might bedspacing matter? Caring for these patients may seem to present only the minor inconvenience to physicians of making short trips off their home ward to visit the floor of some other clinical service. The potential problem arises with undermining multidisciplinary care. While physician care is delivered by the admitting service, the off-service ward staff provide nursing care, pharmacy medication reconciliation, physiotherapy, swallowing assessments, occupational therapy and social work support. These different services tend to function more cohesively when the individual health professionals involved can interact face to face and, even more importantly, know each other well. Bedspacing thus separates the physicians caring for the patient from the other health professionals on the patient’s care team. Thus, one might well expect difficulties with care coordination for bedspaced patients, manifesting as longer hospital lengths of stay in at least one study.6

Despite the enthusiasm of system planners and ED policy makers for bedspacing, evidence for this approach remains …

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