Improving the Hallway Bed Experience in Emergency Department

Updated: Feb 13, 2019

INTRODUCTION Nationally, over 90% of emergency departments (EDs) experience overcrowding. In an effort to meet demand, EDs have resorted to providing treatment to patients in beds placed in hallways. Despite recognition that this temporary solution can lead to suboptimal care, use of hallway beds remains standard practice. In collaboration with Michigan Medicine Emergency Department, the design team sought to investigate the current practice of hallway bed care to formulate and propose solutions to improve the care and experience of hallway bed patients.



Observation and Affinity Mapping

The team conducted 120 hours of observation within the ED. We considered hallway bed care at different locations, times of the day and week, as well as interactions between care providers, patients and others.

Through Affinity Mapping, we identified three primary areas of concern :

Communication: Barriers arise when staff are reluctant or unsure how to discuss the hallway bed process. This leaves patients uninformed and confused which creates anxiety and frustration.

Environment: Patients and staff can encounter pain points due to the physical space and the sensory experience (light, noise and sound) in the hallways. This environment differs in each of the specific hallway bed locations.

Privacy : Multiple times during the ED process, the lack of privacy (either physical or personal information privacy) is painful for both patient and staff.

Patient- Staff Journey Map

The team mapped patient and staff “pain points” over time to deepen our understanding of the process of care and barriers that arise for both a patient and staff during the hallway bed experience.

Patient- Staff Pain Point Analysis

The team found that most pain-points occur within the “communication about process” row and the “waiting” column. Patients do not know what to expect within the hallway bed process and staff are uncertain how to communicate to patients. This analysis helped us determine the opportunity areas in which we believe interventions would have the most impact.

The environmental factors we observed are charted on a spectrum; larger circles represent significant exposure and smaller circles minimal exposure. Staff accessibility follows the same system with the larger circle indicating more access to staff. We acknowledge that light and temperature are subjective variables and a patient may experience these factors differently depending on their symptoms. Here, the larger the circle the more light and warmer temperature the patient is exposed to and vice versa.


  • This project paved the way for critical thinking about the importance of visualizing design insights. When these observation-based findings of the sensory environment of the different locations in the Emergency Department were shared with the partner, it evoked great sympathy. Through this experience, I once again recognized the importance of making the design process visible and bringing the conversation to the table.

  • With this first design project, the team’s passion increased, and we spent a significant amount of time in observation (120 hours). As time passed, we uncovered that there were connections between the patient’s experience and the provider’s experience, and we learned the importance of seeing these connections throughout the design process.

  • As the Emergency Department contains many different objects, I made an exciting discovery by utilizing observation and patient interviews. I became aware of how discrete objects have agency and meaning within the environment. This was a refreshingly new and exciting experience for me, as I did not have a design background prior to my graduate program.