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Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department

Published:October 20, 2016DOI:https://doi.org/10.1016/j.jen.2016.07.003

      Introduction

      In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014.

      Methods

      Covariates significantly correlated with time to diagnostic evaluation, and factors associated with timely care in emergency departments were included in the stepwise linear regression analysis. Differences in nurse staffing and performance measures in trauma and nontrauma emergency departments were examined with analysis of variance and t tests.

      Results

      Two predictors explained 38% of the variance in time a diagnostic evaluation (1): nurse staffing (P < .001) and (2) trauma centers (P <.001). In trauma centers, the time to a diagnostic evaluation significantly increased (P = .042) from 30.2 minutes when a nurse cared for fewer than 11.32 patients in 24 hours to 61.4 minutes when a nurse cared for 14.85 or more patients in 24 hours.

      Discussion

      Efforts to improve patient flow often focus on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units. In this study, time to diagnostic evaluation significantly increased when emergency nurses care for higher numbers of patients. The findings present new evidence identifying the relationship of specific nurse to patient ratios to wait time in emergency departments.

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      References

        • Bornemann-Shepherd M
        • Le-Lazar J
        • Makic MBF
        • DeVine D
        • McDevitt K
        • Paul M
        Caring for inpatient boarders in the emergency department: improving safety and patient and staff satisfaction.
        J Emerg Nurs. 2015; 41: 23-29
        • Emergency Nurses Association
        Position statement: holding, crowding, and patient flow.
        (Published July 2014. Accessed August 11, 2016)
        • Joint Commission
        Standards revisions addressing patient flow through the emergency department.
        (Published July 2012. Accessed August 11, 2016)
        • Baker SJ
        • Shupe R
        • Smith D
        Driving efficient flow: three best-practice models.
        J Emerg Nurs. 2013; 39: 481-484
        • Shindul-Rothschild J
        • Gregas M
        Patient turnover and nursing employment in Massachusetts hospitals before and after health insurance reform: implications for the Patient Protection and Affordable Care Act.
        Policy Polit Nurs Pract. 2014; 14: 151-162
        • Smulowitz PB
        • O’Malley J
        • Yang X
        • Landon BE
        Increased use of the emergency department after health care reform in Massachusetts.
        Ann Emerg Med. 2014; 64: 107-115
        • Anderson D
        • Pimentel L
        • Golden B
        • Wasil E
        • Hirshon JM
        Drivers of ED efficiency: a statistical and cluster analysis of volume, staffing and operations.
        Am J Emerg Med. 2016; 34: 155-161
        • Elder E
        • Johnston ANB
        • Crilly J
        Systematic review of three key strategies designed to improve patient flow through the emergency department.
        Emerg Med Australas. 2015; 27: 394-404
        • Otegbeye M
        • Scriber R
        • Ducoin D
        • Glasofer A
        Designing a data-driven decision support tool for nurse scheduling in the emergency department: a case study of a southern New Jersey emergency department.
        J Emerg Nurs. 2015; 41: 30-35
        • Youd J
        Workforce planning for urgent care services.
        Emerg Nurse. 2015; 25: 14
        • Myers RA
        • Parikh PJ
        • Ekeh AP
        • Denlinger E
        • McCarthy MC
        Scheduling of advanced practice providers at level 1 trauma centers.
        Trauma Acute Care Surg. 2014; 77: 176-181
        • Ducharme J
        • Alder RJ
        • Pelletier C
        • Murray D
        • Tepper J
        The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments.
        CJEM. 2009; 11: 455-461
        • Klauer K
        Innovative staffing in emergency departments: the role of midlevel providers.
        CJEM. 2013; 15: 134-140
        • Stang AS
        • Crotts J
        • Johnson DW
        • Hartling L
        • Guttmann A
        Crowding measure associated with the quality of emergency department care: a systematic review.
        Acad Emerg Med. 2015; 22: 643-656
        • Gabayan GZ
        • Derose SF
        • Chiu VY
        • et al.
        Emergency department crowding and outcomes after emergency department discharge.
        Ann Emerg Med. 2015; 66: 483-492
        • Minick P
        • Clark PC
        • Dalton JA
        • Home E
        • Greene D
        • Brown M
        Long-bone fracture pain management in the emergency department.
        J Emerg Nurs. 2012; 38: 211-217
      1. American Medical Association. Hospital outpatient department quality measures ED-throughput. http://www.stroudwater.com/downloads/TN/OP20&22.pdf. Accessed August 11, 2016.

        • Medicare Quality Improvement Organization for Alabama
        Outpatient quality reporting quick reference guide: clinical measures education.
        (Published 2014. Accessed August 11, 2016)
        • Centers for Medicare and Medicaid Services
        Hospital Compare Data. Timely and effective care–hospital, January 1, 2013–December 31, 2014.
        (Accessed September 18, 2015)
      2. Massachusetts Center for Health Information and Analysis 2010–2014. Hospital profiles.
        (Accessed August 11, 2015)
        • Massachusetts Hospital Association
        PatientCareLink Staffing Plans and Reports, 2013-2014.
        (Accessed February 1, 2015)
        • American Hospital Association
        The AHA annual survey database.
        American Hospital Association, Chicago, IL2009
        • IBM Corp
        SPSS Statistics for Windows, version 21.0.
        IBM Corp, Armonk, NY2012
        • Dartmouth Atlas of Health Care
        Data by region.
        (Accessed August 11, 2016)
        • Chan TC
        • Killeen JP
        • Vilke GM
        • Marshall JB
        • Castillo EM
        Effect of mandated nurse-patient ratios on patient wait time and care time in the emergency department.
        Acad Emerg Med. 2010; 17: 545-552
        • McHugh M
        • Van Dyke KJ
        • Yonek J
        • Moss D
        Time and expenses associated with the implementation of strategies to reduce emergency department crowding.
        J Emerg Nurs. 2012; 38: 420-428
        • McClelland MS
        • Jones K
        • Siegel B
        • Pines JM
        A field test of time-based emergency department quality measures.
        Ann Emerg Med. 2012; 59: 1-10.e2
        • Hwang JI
        • Chang H
        Impact of nurse staffing level on emergency department market share.
        Health Care Manage Rev. 2007; 32: 245-252
        • Wiler JL
        • Welch S
        • Pines J
        • Schuur J
        • Jouriles N
        • Stone-Griffith S
        Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.
        Acad Emerg Med. 2015; 22: 542-553
        • Eappen S
        • Keohan C
        Patient safety alert: missed and delayed diagnoses in the ED.
        Risk Manag Found Harvard Med Institutions. 2014; (Accessed November 12, 2015)

      Biography

      Judith Shindul-Rothschild is Associate Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Catherine Y. Read is Associate Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Kelly D. Stamp is Associate Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Jane Flanagan is Associate Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Linked Article

      • The Advanced Practice Nurse in the Emergency Department
        Journal of Emergency NursingVol. 43Issue 6
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          Thank you for noting the importance of tracking nursing and advanced practice nurse (APN) hours when concerned with time to diagnostic evaluation in the emergency department, in the article “Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department.”1 This is vital information, as delay in evaluation will certainly affect patient care, outcomes, and patient satisfaction. After working in the emergency department for 3 years, the value of employing nurse practitioners was evident.
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