title: ED crowding and the use of nontraditional beds.
abstract: OBJECTIVE
  In an effort to compensate for crowding, many emergency departments (EDs) evaluate and treat patients in nontraditional settings such as gurneys in hallways and conference rooms. The impact of this practice on ED evaluation time is unknown.
  
  
  METHODS
  A historical cohort of adult ED visits to an academic hospital between August 1, 2009 and August 1, 2010, was used to evaluate the relationship between ED bed assignment (traditional, hallway, or conference room bed) and mean ED evaluation time, defined as the time spent in an ED bed before admission or discharge. Chief complaints were categorized into the 5 most frequent categories: abdominal/genitourinary, joint/muscle, general (fever, malaise), head/neck, and other. Multiple linear regression and marginal prediction were used to calculate the mean ED evaluation times for each bed type, overall, and by chief complaint category.
  
  
  RESULTS
  During the study period, 15 073 patient visits met the inclusion criteria. After adjustment for patient and ED factors, assignments to hallway and conference room beds were associated with increases in a mean ED evaluation time of 13.3 minutes (95% confidence interval, 13.2-13.3) and 10.9 minutes (95% confidence interval, 10.8-10.9), respectively, compared with the traditional bed ED evaluation time. This varied by chief complaint category.
  
  
  CONCLUSIONS
  Use of nontraditional beds is associated with increases in mean ED evaluation time; however, these increases are small and may be further minimized by restricting the use of nontraditional beds to patients with specific chief complaints. Nontraditional beds may have a role in improving ED throughput during times of crowding.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN 37232, USA. candace.mcnaughton@vanderbilt.edu
authors.forename: Candace
authors.initials: C
authors.lastname: McNaughton
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.forename: Ian D
authors.initials: ID
authors.lastname: Jones
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Ning
authors.initials: N
authors.lastname: Chen
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Stephan
authors.initials: S
authors.lastname: Russ
mesh_terms: D000328:Adult; D001513:Beds / Q000706:statistics & numerical data; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013997:Time Factors