Interventions according to patient severity in an emergency department based short stay unit: Nursing intervention...

To examine the operational performance of a short stay unit (SSU) and emergency department (ED) and identify the patterns of nursing interventions provided simultaneously to critically ill patients according to the severity of illness in the SSU using the Nursing Intervention Classification System and social network analysis.

This is a retrospective descriptive study. Data were collected from the electronic medical records of critically ill patients admitted to the SSU and ED of a university-affiliated tertiary general hospital between 1 June 2020 and 31 May 2022.

Among the 48,985 ED visits for medical treatment before the SSU was launched, 2,289 (4.7 %) were hospitalised with severe illnesses. Among the 50,650 ED visits for medical treatment after the launch of the SSU, 2820 (5.5 %) were hospitalised with severe illnesses. A total of 551 patients with severe illnesses were admitted to the SSU via the ED during the study period. The respective occupancy rates of the SSU and ED were 25.2 % and 111.3 %. The median length of stays in the ED before and after the launch of the SSU were 8.05 h and 8.75 h. The SSU helped buffer the ED from receiving 531 more patients with severe illnesses without meaningfully increasing ED crowding. As patient severity increased, so did the need for complex physiological care, increasing from 48.3% in Class I to 56.9% in Class IV. Meanwhile, safety and health system-related interventions were more frequently provided to less severe patients, rising from 11.8 % and 8.5 %. in Class IV to 17.6 % and 14.7 % in Class I, respectively. Social network analysis showed that the clustering of emergency care was consistently centralised, regardless of severity, with ventilatory support and metabolic interventions becoming more prominent as patient severity increased.

This study provided a comprehensive understanding of the evolving priorities of nursing interventions across patient severity levels at the SSU of a tertiary general hospital. This study can serve as a reference to enable nurses to efficiently provide complex and interrelated nursing interventions for patients, ultimately improving patient outcomes in acute care settings. These insights may help other general hospitals refine their acute care models and guide future research on best practices for managing critically ill patients outside traditional ICU settings.