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


Often, ED throughput metrics are equated to ED performance metrics. Thus, we are constantly seeking to understand the factors that impact our facility's performance. One of those factors in our study was nurse staffing. Suboptimal nurse staffing may impact a number of nursing tasks such as triage, vital signs, phlebotomy, medication administration, procedures, and discharge education. As nursing delays accumulate, this translates into longer wait times, leading to more patients who LWBS. It is likely that nurse staffing levels affect all important steps in a patient's path through the department[13] and has previously been shown to impact patient safety.[11,12] Cost analysis may delineate whether increased nurse staffing drives up front-end costs, but also generates additional revenue through more patient evaluations and decreased LWBS rates. Ultimately, expenses and revenue related to staffing and throughput are likely institutionally specific, but it is an important consideration nonetheless.

Nationwide nursing shortages continue to be an ongoing issue. High nursing turnover, changes to overtime rules and lengthy hiring processes, among other factors, can all contribute to nursing shortages and decreased nursing hours in EDs. Our study further contributes to the body of evidence that decreased nurse staffing directly contributes to the number of patients who LWBS and increased ED LOS, which is also shown to decrease patient satisfaction.[15] Chang showed that organizational characteristics associated with decreased ED LOS included executive leadership involvement, hospital-wide coordinated strategies, data-driven management, and performance accountability.[16] 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.