New Findings from Yale University in the Area of Managed Care Described (Inequities Among Patient Placement In Emergency Department Hallway Treatment Spaces): Managed Care

2024 FEB 07 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- Research findings on Managed Care are discussed in a new report. According to news reporting out of New Haven, Connecticut, by NewsRx editors, research stated, “Limited capacity in the emergency department (ED) secondary to boarding and crowding has resulted in patients receiving care in hallways to provide access to timely evaluation and treatment. However, there are concerns raised by physicians and patients regarding a decrease in patient centered care and quality resulting from hallway care.”

Our news journalists obtained a quote from the research from Yale University, “We sought to explore social risk factors associated with hallway placement and operational outcomes.Study design/methods: Observational study between July 2017 and February 2020. Primary outcome was the adjusted odds ratio (aOR) of patient placement in a hallway treatment space adjusting for patient demographics and ED operational factors. Secondary outcomes included left without being seen (LWBS), discharge against medical advice (AMA), elopement, 72-h ED revisit, 10-day ED revisit and escalation of care during boarding. Among 361,377 ED visits, 100,079 (27.7%) visits were assigned to hallway beds. Patient insurance coverage (Medicaid (aOR 1.04, 95% CI 1.01,1.06) and Self-pay/Other (1.08, (1.03, 1.13))) with comparison to private insurance, and patient sex (Male (1.08, (1.06, 1.10))) with comparison to female sex are associated with higher odds of hallway placement but patient age, race, and language were not. These associations are adjusted for ED census, triage assigned severity, ED staffing, boarding level, and time effect, with social factors mutually adjusted. Additionally adjusting for patients’ social factors, patients placed in hallways had higher odds of elopement (1.23 (1.07,1.41)), 72-h ED revisit (1.33 (1.08, 1.64)) and 10-day ED revisit (1.23 (1.11, 1.36)) comparing with patients placed in regular ED rooms. We did not find statistically significant associations between hallway placement and LWBS, discharge AMA, or escalation of care. While hallway usage is ad hoc, we find consistent differences in care delivery with those insured by Medicaid and self-pay or male sex being placed in hallway beds.”

According to the news editors, the research concluded: “Further work should examine how new front-end processes such as provider in triage or split flow may be associated with inequities in patient access to emergency and hospital care.”

This research has been peer-reviewed.

For more information on this research see: Inequities Among Patient Placement In Emergency Department Hallway Treatment Spaces. The American Journal of Emergency Medicine, 2024;76:70-74. The American Journal of Emergency Medicine can be contacted at: W B Saunders Co-elsevier Inc, 1600 John F Kennedy Boulevard, Ste 1800, Philadelphia, PA 19103-2899, USA.

Our news journalists report that additional information may be obtained by contacting Kwame Tuffuor, Yale University, School of Medicine, Dept. of Emergency Medicine, New Haven, CT 06510, United States. Additional authors for this research include Asim Tarabar, Reinier Van Tonder, Chris Chmura, Vivek Parwani, Arjun K. Venkatesh, Rohit B. Sangal, Huifeng Su, Lesley Meng and Edieal Pinker.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1016/j.ajem.2023.11.013. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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