Decreased nursing staffing adversely affects emergency department throughput metrics

Zachariah Ramsey*, Joseph S. Palter, John Hardwick, Jordan Moskoff, Errick L. Christian, John Bailitz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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. [West J Emerg Med. 2018;19(3)496-500.]

Original languageEnglish (US)
Pages (from-to)496-500
Number of pages5
JournalWestern Journal of Emergency Medicine
Volume19
Issue number3
DOIs
StatePublished - May 2018

ASJC Scopus subject areas

  • Emergency Medicine

Fingerprint Dive into the research topics of 'Decreased nursing staffing adversely affects emergency department throughput metrics'. Together they form a unique fingerprint.

Cite this