Waiting room and hallway care for older adults: a qualitative study with emergency nurses and technicians.

BACKGROUND: Emergency Department (ED) crowding places older ED patients at risk for adverse outcomes. Crowding often necessitates ED waiting room and hallway care, but there has been limited research on approaches to care for older adults in these settings. Frontline clinician insights can inform best practices for older adults in the context of the ongoing ED crowding crisis. Our objective was to describe the experiences of emergency nurses and technicians in providing waiting room and hallway care for older adults. METHODS: This qualitative study used individual, semi-structured interviews with a purposive sample of 20 ED nurses and technicians at a single urban, academic trauma center. Interviews took place between November 2023 and March 2024 and focused on challenges faced in triage and when providing care in the ED waiting room / hallways. We analyzed interview transcripts through thematic analysis with a deductive and inductive coding approach. RESULTS: Four major themes related to hallway and waiting room care for older adults emerged: (1) Unique safety concerns for older adults; (2) Limitations to person-centered care; (3) Needed resources; and (4) Adaptations to systemic dysfunction. Participants describe that dedicated waiting room staff, separate spaces for older adults, and rooming protocols that incorporate geriatric syndromes would likely enhance patient safety. CONCLUSIONS: Resource constraints restrict ED clinicians from ensuring safe, high-quality waiting room and hallway care for older adults. Systems-based solutions to improve care for older adults in these settings include transparency and reporting around hospital crowding, safe clinician staffing levels, and investment in dedicated ED spaces for older adults.