Overcrowding, Corridor Care, and Boarding

Background

The issue of healthcare services being over-stretched is not new but has been placed very firmly in the spotlight by the impact of the Covid-19 pandemic. High service demand produces very real and practical concerns about the environments in which care can be safely delivered. When community health and social care capacity is limited, a problem with ‘home-to-home patient flow’ can ensue: hospitals find it hard to discharge patients, emergency departments (ED) find it hard to admit patients to ward care, and ambulances find it hard to off-load patients into the emergency care department. 

This situation leads to care being delivered in areas that were never intended for this purpose. Wards may be asked to ‘board’ patients in corridors or by having additional beds in area’s not designed for that number, ED’s often turn corridors and other areas into waiting spaces  and ambulances can be ‘ramped’ outside EDs unable to handover patients to emergency care staff. As well as the impact on clinical outcomes, experiencing such situations can take a personal toll on both patients and staff, yet the breadth and depth of evidence relating to these experiences has not currently been explored.

Following a tabled discussion about the impact of corridor care on patients and on nursing staff at the 2023 RCN Congress, the RCN requested that the University of Sheffield look into the evidence around this topic as part of the remaining Strategic Research Alliance resource. This work began in Autumn 2023.

Study Design

In order to gather evidence on the personal impact of being cared for in busy environments and non-standard care settings, two rapid reviews were undertaken addressing the question “What are nurses’ and patients’ experiences of ‘corridor care’ or ‘boarding’?”. The first of these was an academic review of the international empirical literature. The second was a UK based review of media content.

Key Findings

The academic review demonstrated that there is only limited available evidence about both patient and staff experiences of caring in busy, non-standard care settings. What evidence there is mainly focused on emergency departments (ED). There is a dearth of evidence considering staff experiences of patients boarding in areas other than the ED, and virtually no evidence of nursing or patient experiences from the UK. 

The media review mainly reported nurses’ experiences, though the few articles that provide patient accounts provide very powerful messages.

Both the academic and media evidence demonstrate a high degree of frustration, stress and dissatisfaction for both staff and patients when faced with overcrowding and the related issues of corridor care and boarding. The limited opportunity for nurses to provide the quality of care they aim to offer, and for patients to receive such care, was the main source of this frustration, stress and dissatisfaction. Such experiences demoralise nursing staff, who fear for their patients and for their own professional integrity. They also distresses patients who often feel abandoned and isolated when they are left in corridors or boarded on wards.

Overcrowding, with patients boarding in corridors, generates a chaotic environment. Staff and patients express concerns about the impact of noise, discomfort, and loss of privacy and dignity. There are also safety concerns when patient movement around the ED makes location, observation, adequate mobilisation, and food/fluid intake monitoring difficult. There are particular concerns when those less well are side-lined as more urgent cases take priority. The subsequent rationing of treatment and care generates guilt, frustration and stress for staff and feelings of distress, vulnerability and abandonment for patients.

When staff and patients are experiencing such pressure, frustration and distress, it can lead to staff looking to leave the workforce and to patients leaving hospital without receiving treatment or even an assessment of their condition. 

Such pressures, experienced within inappropriate care environments, also create tensions in interactions between staff, patients and their relatives which can result in complaints, abuse and episodes of violence. Despite this, the majority of staff and patients are able to empathise with each other’s situation and recognise that the healthcare system is under an intolerable burden that is beyond what both staff and patients should realistically be expected to cope with.

These reports underscore the urgent need for comprehensive solutions to alleviate the strain on both healthcare providers and recipients of care, recognising the shared responsibility of all stakeholders involved.

Publications

Robertson, S., Ryan, T., Talpur, A. Staff and patient experiences of crowding, corridor care and boarding: A rapid review. Emergency Nurse. Published online 18th December 2024. doi: 10.7748/en.2024.e2215