The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

doi:10.1186/s12913-016-1544-x

Comparative Study

. 2016 Jul 19:16:279.

doi: 10.1186/s12913-016-1544-x.

The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

Pierre-Géraud Claret^{1

2}, Xavier Bobbia³, Sylvia Olive³, Christophe Demattei⁴, Justin Yan⁵, Robert Cohendy^{3

6}, Paul Landais^{7

4

6}, Jean Emmanuel de la Coussaye^{3

6}

Affiliations

¹ Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France. pierre.geraud.claret@gmail.com.
² EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France. pierre.geraud.claret@gmail.com.
³ Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
⁴ Department of Biostatistics, Clinical Research, Clinical Epidemiology, and Public Health, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
⁵ Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre and The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
⁶ Montpellier-Nîmes University, 2 rue École de Médecine, 34060, Montpellier, France.
⁷ EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France.

PMID: 27430423
PMCID: PMC4950694
DOI: 10.1186/s12913-016-1544-x

Comparative Study

The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

Pierre-Géraud Claret et al. BMC Health Serv Res. 2016.

. 2016 Jul 19:16:279.

doi: 10.1186/s12913-016-1544-x.

Authors

Pierre-Géraud Claret^{1

2}, Xavier Bobbia³, Sylvia Olive³, Christophe Demattei⁴, Justin Yan⁵, Robert Cohendy^{3

6}, Paul Landais^{7

4

6}, Jean Emmanuel de la Coussaye^{3

6}

Affiliations

¹ Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France. pierre.geraud.claret@gmail.com.
² EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France. pierre.geraud.claret@gmail.com.
³ Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
⁴ Department of Biostatistics, Clinical Research, Clinical Epidemiology, and Public Health, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
⁵ Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre and The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
⁶ Montpellier-Nîmes University, 2 rue École de Médecine, 34060, Montpellier, France.
⁷ EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France.

PMID: 27430423
PMCID: PMC4950694
DOI: 10.1186/s12913-016-1544-x

Abstract

Background: The aim of our study was to investigate the impact of a new organization of our emergency department (ED) on patients' mortality and management delays.

Methods: The ED segmentation consisted of the development of a new patient care geographical layout on a pre-existing site and changing the organization of patient flow. It took place on May 10, 2012. We did a before-after study in the ED of a university hospital, "before" (winter 2012) and "after" (summer 2012) reorganization by segmentation into sectors. All ED patients were included.

Results: Eighty-three thousand three hundred twenty-two patient visits were analyzed, 61,118 in phase "before", 22,204 during the phase "after". The overall inpatient mortality was 1.5 % during summer 2011 ("before" period), 1.8 % during winter 2012 ("before" period), 1.3 % during summer 2012 ("after" period) period (summer 2012 vs. winter 2012, OR = 0.72; 95 % CIs [0.61, 0.85], and summer 2012 vs. summer 2011, OR = 0.85; 95 % CIs [0.72, 0.99]). The mean (SD) time to first medical contact was 129 min (±133) during winter 2012 and 104 min (± 95) during summer 2012 (p < .05).

Conclusions: Our study showed a decrease in mortality and improvement in time to first medical contact after the segmentation of our ED and nursing staffing increase, without an increase in medical personnel. Improving patient care through optimizing ED segmentation may be an effective strategy.

Keywords: Emergency service; Hospital; Nursing staff; Organizations.

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Figures

**Fig. 1**
Study design, “before” and “after” periods

**Fig. 2**
Comparison of ED organization before (a) and after (b) ED segmentation. Sector in green: sector led by a physician, red cross: nurse

**Fig. 3**
Comparison of mortality of patients admitted to the ED in 2011 and 2012, according to the “before” (winter 2012) and “after” (summer 2012) periods. ns: non-significant, *: p < .05, **: p < .01

See this image and copyright information in PMC

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References

1. Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5. doi: 10.1016/j.annemergmed.2007.07.008. - DOI - PubMed
1. Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28:304–309. doi: 10.1016/j.ajem.2008.12.014. - DOI - PubMed
1. Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ. 2011;342:d2983. doi: 10.1136/bmj.d2983. - DOI - PMC - PubMed
1. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–136. doi: 10.1016/j.annemergmed.2008.03.014. - DOI - PMC - PubMed
1. Claret PG, Sebbanne M, Bobbia X, Bonnec JM, Pommet S, Jebali C, et al. First medical contact and physicians’ opinion after the implementation of an electronic record system. Am J Emerg Med. 2012;30:1235–1240. doi: 10.1016/j.ajem.2011.06.014. - DOI - PubMed

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[1] Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5. doi: 10.1016/j.annemergmed.2007.07.008. - DOI - PubMed

[2] Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5. doi: 10.1016/j.annemergmed.2007.07.008. - DOI - PubMed

[3] Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28:304–309. doi: 10.1016/j.ajem.2008.12.014. - DOI - PubMed

[4] Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28:304–309. doi: 10.1016/j.ajem.2008.12.014. - DOI - PubMed

[5] Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ. 2011;342:d2983. doi: 10.1136/bmj.d2983. - DOI - PMC - PubMed

[6] Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ. 2011;342:d2983. doi: 10.1136/bmj.d2983. - DOI - PMC - PubMed

[7] Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–136. doi: 10.1016/j.annemergmed.2008.03.014. - DOI - PMC - PubMed

[8] Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–136. doi: 10.1016/j.annemergmed.2008.03.014. - DOI - PMC - PubMed

[9] Claret PG, Sebbanne M, Bobbia X, Bonnec JM, Pommet S, Jebali C, et al. First medical contact and physicians’ opinion after the implementation of an electronic record system. Am J Emerg Med. 2012;30:1235–1240. doi: 10.1016/j.ajem.2011.06.014. - DOI - PubMed

[10] Claret PG, Sebbanne M, Bobbia X, Bonnec JM, Pommet S, Jebali C, et al. First medical contact and physicians’ opinion after the implementation of an electronic record system. Am J Emerg Med. 2012;30:1235–1240. doi: 10.1016/j.ajem.2011.06.014. - DOI - PubMed

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The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

Affiliations

The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times

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