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Observational Study
. 2018 May;19(3):496-500.
doi: 10.5811/westjem.2018.1.36327. Epub 2018 Apr 5.

Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics

Zachariah Ramsey  1 , Joseph S Palter  1   2 , John Hardwick  1 , Jordan Moskoff  1   2 , Errick L Christian  1 , John Bailitz  3
Affiliations
Observational Study

Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics

Zachariah Ramsey et al. West J Emerg Med. 2018 May.

Abstract

Introduction: The effect of nurse staffing on emergency department (ED) efficiency remains a significant area of interest to administrators, physicians, and nurses. We believe that decreased nursing staffing adversely affects key ED throughput metrics.

Methods: We conducted a retrospective observational review of our electronic medical record database from 1/1/2015 to 12/31/2015 at a high-volume, urban public hospital. We report nursing hours, door-to-discharge length of stay (LOS) and door-to-admit LOS, and percentage of patients who left without being seen (LWBS). ED nursing hours per day was examined across quartiles with the effect evaluated using analysis of covariance and controlled for total daily ED volume, hospital occupancy and ED admission rate.

Results: From 1/1/15-12/31/15, 105,887 patients presented to the ED with a range of 336 to 580 nursing hours per day with a median of 464.7. Independent of daily ED volume, hospital occupancy and ED admission rate, days in the lowest quartile of nursing hours experienced a 28.2-minute increase per patient in door-to-discharge LOS compared to days in the highest quartile of nursing hours. Door-to-admit LOS showed no significant change across quartiles. There was also an increase of nine patients per day who left without being seen by a provider in the lowest quartile of nursing hours compared to the highest quartile.

Conclusion: Lower nursing hours contribute to a statistically significant increase in door-to-discharge LOS and number of LWBS patients, independent of daily ED volume, hospital occupancy and ED admission rate. Consideration of the impact of nursing staffing is needed to optimize throughput metrics for our urban, safety-net hospital.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure
Figure
Daily mean length of stay for discharged and admitted patients as well as daily nursing hours by date. ED, emergency department; DC, discharge.
See this image and copyright information in PMC

References

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