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 authors were not blinded to the hypothesis of this retrospective study during data abstraction; therefore, selection of controls was subject to author bias. The computer-derived data allowed for large data collection, but also contributed to our limitations. It is unknown when discharged patients received final instructions from nurses and hence physically left the ED, as this is not captured in our EMR. We did not address acuity of illness or triage scoring directly, an independent determinant of ED throughput metrics,[14] but rather used the surrogate of ED admission rate. Our analysis only measured data over 24-hour periods. It is possible that certain shifts were affected disproportionately by the decreased nurse staffing.

As a single institution study in an urban, tertiary care, safety-net hospital, our results may not be generalizable to other settings, specifically smaller-volume Eds with smaller nursing staffs. Our hospital spends negligible time on diversion each year so this was not included as a factor, though previous studies[4,5,14] revealed diversion correlates with worsened throughput performance. Lastly, because the statistical method was designed to show correlation rather than causation, other confounding factors may contribute.