Nurse staffing and care process factors in paediatric emergency department-An administrative data study

To describe the nurse-patient ratio in the paediatric emergency department and whether it is related to emergency care process measurements: length of stay and the number of patients who leave before treatment is completed.

Despite abundant data on nurse staffing, little is known about its relationship with process variables in paediatric emergency departments.

This was a cross-sectional study. Administrative data regarding 21,956 patients and nurse staffing (N = 49) were collected from a university hospital's paediatric emergency department between 1 January-30 June 2019. Summary statistics were calculated, differences in the variables were assessed by Kruskal-Wallis and chi-square tests, and relations between them were explored by linear regression analysis. This study is reported in accordance with the STROBE guidelines.

Nurse-patient ratios varied between shifts and were highest at night (mean 0.75; range 0.3-5.3) and the lowest in the evenings (mean 0.17; range 0.1-0.8). Increases in numbers of nurses in the paediatric emergency department reduced the length of stay by 2% per additional nurse on average, and nurse-patient ratios were negatively related to frequencies of patients leaving before treatment completion.

The results indicate that nurse-patient ratios affect paediatric patient care processes. Staffing levels are negatively related to emergency department length of stay and influence factors that could reduce numbers of patients who leave before treatment completion.

Because the nurse-patient ratio affects the care process, it should be used together with other process measurements when assessing care quality in paediatric emergency departments.