When Nurse Staffing Lags, ER Performance Does, Too

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By Kenneth Michek

Ask a nurse and they will tell you that staffing levels matter. Now a study published in the Western Journal of Emergency Medicine lends support to that popular opinion.

The study supplies further evidence for nurse leaders to make the case for nursing’s role in achieving healthcare outcomes and metrics.

“Our study provides additional data that may help providers further engage hospital administration to supply adequate nurse staffing that allows EDs to better achieve performance goals and improve the patient experience,” the researchers write. “This analysis is a pivotal step in identifying and ensuring appropriate nurse staffing to optimize ED quality metrics.”

More Nurses, Better Outcomes

In a retrospective observational review of the electronic medical record database from a high-volume, urban public hospital, researchers compared nursing hours per day with door-to-discharge length of stay, door-to-admission LOS, and the percentage of patients who left without being seen.

From January to December 2015, more than 100,000 patients were seen in the ED at an average of 290 visits each day. During this time, the ED had an average of 465 nursing hours worked per day.

Researchers found:

  • Regardless of daily patient volume, occupancy, and ED admission rates, days in the lowest quartile of nursing hours experienced a 28-minute increase per patient door-to-discharge LOS when compared with the highest quartile of nursing hours.
  • Door-to-admit LOS showed no significant change across quartiles.
  • There was an increase of 9 patients per day that left without being seen by a provider from the lowest to highest quartile of nursing hours.

The authors concluded:

  • Lower staffing rates contribute to a statistically significant increase in wait time for patients, which then impacts how many patients receive treatment each day.

In addition to the clear patient safety and patient satisfaction issues around patients failing to receive timely treatment, the decrease in patients seen can also impact throughput metrics and decrease the overall revenue of facilities.