Hospitals place patients in overflow beds when specialty departments reach capacity, maintaining patient flow but potentially compromising patient safety. This study examines how hospitals address these risks in daily decision-making. Using a qualitative, single-center approach, data were collected through observations, hospital documentation, and 12 semi-structured interviews. Inductive thematic analysis identified three key challenges: (1) balancing operational efficiency with clinical suitability, (2) interdepartmental collaboration difficulties, and (3) safety risks for outlying patients.

Findings revealed that the Patient Flow Coordinator (PFC) leads overflow placements using structured tools, but nurses’ limited specialty knowledge contributes to delays and increased length of stay. Existing mitigation strategies include repatriation, decision-making support, and signaling quality concerns.

This study contributes to healthcare management by mapping overflow placement processes and identifying systemic challenges. Recommendations include fostering shared responsibility, enhancing interdepartmental knowledge-sharing, and formalizing decision-making. Future research should evaluate the proposed relationship between decision-making, interdepartmental collaboration, and patient safety risks.