Measuring patient dependency--performance of the Jones Dependency Tool in an Australian emergency department

The emergency department (ED) is a dynamic environment, in which a high volume of undifferentiated patients with varying levels of urgency must be assessed and treated in a timely manner, primarily by nurses. Nurses not only provide initial but also continuing care for all patients presenting to the ED. Predicting the number of nurses required and the ideal ratio of nursing staff to patients presenting is complex. Current methods of predicting ED nursing workforce fail to reflect the severity and variability of illness/injury or case mix. In addition, they exclude the realities of patients have different nursing requirements, that patient stability changes frequently and that issues such as patient surge (sudden high volumes of presentations) do occur. The aim of this study was to examine the potential for using the Jones Dependency Tool (JDT) for determining patient dependency in the Australian context.

A prospective cohort study design based upon a convenience sample of patients was conducted over a randomly selected two-week period.

The JDT proved both valid, reliable and sensitive to changes in patient's status. The majority of patient presentations occurred from 6 am to 3 pm, patient dependency peaked from 3 pm to 6 pm, and then continued to rise over night when the least nursing staff are allocated to work. The majority (n=321, 50%) of the patients presenting to the ED were of moderate dependency. As patient dependency increased, patients were allocated to treatment areas with higher nurse-patient ratios. Patients allocated to the ambulance bay, which is not routinely staffed by nurses, were found to have similar levels of moderate to high dependency as those managed in the acute or resuscitation bay, therefore patients are reliant upon ambulance personnel for their care needs. Patient dependency was found to increase with age and degree of immobility. The JDT is sensitive to changes in patient's dependency over time, and may assist with discharge planning or ward handover.

This study has demonstrated that the JDT can consistently measure patient dependency within one Australian adult ED. Further testing of the JDT needs to be undertaken in order to explore the potential for the tool to contribute to nurse-patient ratio models and patient communication handover.