Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics

Area of Science:

• Healthcare Management
• Emergency Medicine
• Nursing Administration

Background:

• Emergency department (ED) efficiency is crucial for patient care and hospital operations.
• The impact of nurse staffing levels on ED throughput metrics is a key concern for healthcare stakeholders.

Purpose of the Study:

• To investigate the relationship between daily nurse staffing levels and ED efficiency.
• To determine how variations in nursing hours affect patient length of stay (LOS) and the rate of patients leaving without being seen (LWBS).

Main Methods:

• Retrospective observational study of electronic medical records from a high-volume urban public hospital (1/1/2015–12/31/2015).
• Analysis of nursing hours per day, door-to-discharge LOS, door-to-admit LOS, and LWBS rates.
• Statistical analysis (ANCOVA) controlling for daily ED volume, hospital occupancy, and ED admission rate.

Main Results:

• Days with the lowest quartile of nursing hours showed a 28.2-minute increase in door-to-discharge LOS per patient compared to the highest quartile.
• No significant change in door-to-admit LOS was observed across nursing hour quartiles.
• An increase of nine patients per day left without being seen (LWBS) in the lowest nursing hour quartile compared to the highest.

Conclusions:

• Reduced nursing hours are statistically linked to longer door-to-discharge LOS and increased LWBS rates, irrespective of other ED volume factors.
• Nurse staffing levels significantly influence ED throughput and patient flow.
• Optimizing ED performance, particularly in urban safety-net hospitals, necessitates attention to nursing staff allocation.