IntroductionThe effect of nurse staffing on emergency department (ED) efficiency remains a significant area of interest to administrators, physicians, and nurses. We believe that decreased nursing staffing adversely affects key ED throughput metrics.MethodsWe conducted a retrospective observational review of our electronic medical record database from 1/1/2015 to 12/31/2015 at a high-volume, urban public hospital. We report nursing hours, door-to-discharge length of stay (LOS) and door-to-admit LOS, and percentage of patients who left without being seen (LWBS). ED nursing hours per day was examined across quartiles with the effect evaluated using analysis of covariance and controlled for total daily ED volume, hospital occupancy and ED admission rate.ResultsFrom 1/1/15–12/31/15, 105,887 patients presented to the ED with a range of 336 to 580 nursing hours per day with a median of 464.7. Independent of daily ED volume, hospital occupancy and ED admission rate, days in the lowest quartile of nursing hours experienced a 28.2-minute increase per patient in door-to-discharge LOS compared to days in the highest quartile of nursing hours. Door-to-admit LOS showed no significant change across quartiles. There was also an increase of nine patients per day who left without being seen by a provider in the lowest quartile of nursing hours compared to the highest quartile.ConclusionLower nursing hours contribute to a statistically significant increase in door-to-discharge LOS and number of LWBS patients, independent of daily ED volume, hospital occupancy and ED admission rate. Consideration of the impact of nursing staffing is needed to optimize throughput metrics for our urban, safety-net hospital.
group, multiplied by 100,000 to equal the pediatric emergency department mortality rate per 100,000 visits.Results: Pediatric injury mortality in Arizona emergency departments varied from 39.8 deaths per 100,000 ED visits to 25.6 deaths per 100,000 ED visits in the pre-certification and post-certification groups, respectively. Comparing the certified emergency department's pediatric mortality rate to the overall pediatric injury mortality rate demonstrated 25.6 deaths versus 35.5 deaths respectively. Analysis of the pediatric mortality rates per 1,000 hospitalizations in the time period before initiation of the designation program (2009-2011) to the time period following initiation of the program (2012-2014) demonstrated a greater rate difference between certified and non-certified hospitals post-certification (7.9 versus 10.2 and 10.8 versus 17.5; respectively).Conclusion: The Arizona emergency department pediatric designation system resulted in a decrease in pediatric injury mortality post certification. Institutional certification also resulted in a reduction of inpatient pediatric injury mortality when compared to the non-certified hospitals in the same time period.
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