HALT-Sepsis: Hallway Assignment Linked to Treatment Delays in Sepsis

Hallway care has become increasingly common due to emergency department (ED) crowding, but little is known about its impact on care for time-sensitive conditions. Sepsis is a time-sensitive condition in which delays to critical interventions, such as time to antibiotic administration, is associated with increased morbidity and mortality. This study examined whether initial triage to an ED hallway among high-risk patients with concern for sepsis is associated with delays in key sepsis interventions.

We performed a retrospective cohort study of adult encounters at a quaternary care academic ED from July 1, 2022 to June 30, 2024. Eligible patients had a clinical concern for sepsis, defined by both having blood cultures drawn and IV antibiotics administered, and either unstable triage vitals [systolic blood pressure (SBP) <90 mmHg, oxygen saturation <88%, heart rate (HR) >130 or <40 beats per minute, or shock index (HR/SBP) >1] or an ICU disposition. Patients were categorized by initial placement in a hallway stretcher or treatment room. Descriptive statistics compared time from arrival to provider evaluation, provider evaluation to antibiotic administration, and other early care processes.

Among 2,211 encounters, 568 (26%) were initially placed in hallway stretchers and 1,643 (74%) in treatment rooms. Hallway patients had significantly longer median times to provider evaluation (23.9 vs 18.1 min, p < 0.05) and antibiotic administration (162.9 vs 121.8 min, p < 0.05). Initiation of fluid resuscitation, laboratory test completion, and ED length of stay were also longer among hallway placements.

High-risk patients with a clinical concern for sepsis experienced meaningful delays in time-sensitive care when initially triaged to hallway stretchers. Given the well-established evidence base for sepsis management, these findings underscore ED crowding and hallway triage practices as critical operational barriers to delivering timely, guideline-concordant sepsis care.