Ending corridor care for the dying: reverse boarding of end-of-life patients before and after a dedicated end-of-life ward

Introduction
“Reverse boarding” — moving inpatients into corridors and other non-bed spaces to create capacity — is an acknowledged harm of hospital crowding, and NHS England has set a standard of zero. For patients dying in hospital the indignity is particularly acute. We examined whether opening a dedicated end-of-life care ward changed the exposure of dying patients to reverse boarding.

Methods
Routinely collected bed-management data (2021–2026) were analysed. End-of-life status was defined using stable markers held before the boarding event; ReSPECT documentation alone was deliberately excluded as a marker as it is present in around one in five of all spells. The share of reverse-boarded spells involving end-of-life patients was compared before and after ward opening (5,835 pre and 642 post spells), with rate ratios and 95% confidence intervals.

Results
Between 2021 and 2025, end-of-life patients comprised 10–15% of several hundred to over a thousand reverse-boarded spells annually. After the ward opened, the end-of-life share of reverse-boarded spells halved, from 17.4% to 8.9% (rate ratio 0.51, 95% CI 0.40–0.66; p<0.001); weekly end-of-life reverse-boarding events fell from 21.4 to 12.4. Total reverse boarding continued, indicating the change was specific to dying patients rather than a general easing of crowding.

Conclusions
A dedicated end-of-life care ward was associated with a halving of corridor care for the dying within weeks of opening. The post-period is short and confounding cannot be excluded; monthly monitoring now reports to our quality committee, with a bed-management flag prioritising dying patients for side rooms.