Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics

Zachariah Ramsey, MD; Joseph S. Palter, MD; John Hardwick, MD; Jordan Moskoff, MD; Errick L. Christian, MS; John Bailitz, MD


Western J Emerg Med. 2018;19(3):496-500. 

In This Article


The mean number of visits per day was 290 with a range of 129 – 425. Nursing hours ranged from 336 – 580 nursing hours per day with a median of 464.7. The daily mean LOS for discharged patients was 249.8 minutes, and the range was 155 – 389. The daily mean LOS for admitted patients was 441.5 minutes, and the range was 259 – 796. The ED mean admission rate was 17.5% with a range of 10.8% – 23.9%. The daily mean of patients that LWBS was 17.5 and totaled 6,387 with a range of 1 – 55 patients per day. The daily mean hospital occupancy was 98.3%, and the range was 68.5% – 116.3%. The Figure depicts the daily mean LOS for discharged and admitted patients as well as nursing hours by date throughout the course of the study.


Daily mean length of stay for discharged and admitted patients as well as daily nursing hours by date. ED, emergency department; DC, discharge.

Outcome variables are summarized in the Table. ED door-to-discharge LOS and the number of patients who LWBS were both significantly affected by a decrease in daily nursing hours independent of ED daily volume, hospital occupancy and 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. Across these same quartiles, days in the lowest quartile of nursing hours observed an increase of nine patients that LWBS per day. Both these differences were statistically significant. Door-to-admit LOS was not significantly affected by nursing hours. In the case of door-to-discharge LOS and number of patients that LWBS, while comparing adjacent quartiles did not always lead to statistically significant differences, there was a clear trend in the data across the quartiles that showed correlation.