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Safe staffing for nursing in emergency departments: evidence review

Safe staffing for nursing in emergency departments: evidence review
Safe staffing for nursing in emergency departments: evidence review
OBJECTIVE: Getting staffing levels wrong in hospitals is linked to excess mortality and poor patient experiences but establishing the safe nurse staffing levels in the emergency department (ED) is challenging because patient demand is so variable. This paper reports a review conducted for the National Institute for Health and Care Excellence (NICE) which sought to identify the research evidence to inform UK nursing workforce planning.

DESIGN: We searched 10 electronic databases and relevant websites for English language studies published from 1994. Studies included reported a direct measure of nurse staffing relative to an activity measure (eg, attendances, patient throughput) or an estimate of nurse staffing requirements. Randomised or non-randomised trials, prospective or retrospective observational, cross-sectional or correlational studies, interrupted time-series, and controlled before and after studies were considered.

RESULTS: We identified 16,132 items via databases and 2193 items through manual and other searching. After title/abstract screening (by one reviewer, checked by a second) 55 studies underwent full assessment by the review team. 18 studies met the inclusion criteria for the NICE review, however 3 simulation studies that reported simulated rather than measured outcomes are not reported here.

CONCLUSIONS: The evidence is weak but indicates that levels of nurse staffing in the ED are associated with patients leaving without being seen, ED care time and patient satisfaction. Lower staffing is associated with worse outcomes. There remain significant gaps and in particular a lack of evidence on the impact of staffing on direct patient outcomes and adequate economic analyses to inform decisions about nurse staffing. Given that an association between nurse staffing levels and patient outcomes on inpatient wards has been demonstrated, this gap in the evidence about nurse staffing in EDs needs to be addressed.
1472-0205
888-894
Recio, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Crouch, Robert
7f98a42e-ee34-4520-ab33-83cd3acf05b7
Drennan, Jonathan
dad7b3ad-8b7d-428b-8dea-ccb1d50819eb
Recio, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Crouch, Robert
7f98a42e-ee34-4520-ab33-83cd3acf05b7
Drennan, Jonathan
dad7b3ad-8b7d-428b-8dea-ccb1d50819eb

Recio, Alejandra, Pope, Catherine, Dall'ora, Chiara, Griffiths, Peter, Jones, Jeremy, Crouch, Robert and Drennan, Jonathan (2015) Safe staffing for nursing in emergency departments: evidence review. Emergency Medicine Journal, 32 (11), 888-894.

Record type: Article

Abstract

OBJECTIVE: Getting staffing levels wrong in hospitals is linked to excess mortality and poor patient experiences but establishing the safe nurse staffing levels in the emergency department (ED) is challenging because patient demand is so variable. This paper reports a review conducted for the National Institute for Health and Care Excellence (NICE) which sought to identify the research evidence to inform UK nursing workforce planning.

DESIGN: We searched 10 electronic databases and relevant websites for English language studies published from 1994. Studies included reported a direct measure of nurse staffing relative to an activity measure (eg, attendances, patient throughput) or an estimate of nurse staffing requirements. Randomised or non-randomised trials, prospective or retrospective observational, cross-sectional or correlational studies, interrupted time-series, and controlled before and after studies were considered.

RESULTS: We identified 16,132 items via databases and 2193 items through manual and other searching. After title/abstract screening (by one reviewer, checked by a second) 55 studies underwent full assessment by the review team. 18 studies met the inclusion criteria for the NICE review, however 3 simulation studies that reported simulated rather than measured outcomes are not reported here.

CONCLUSIONS: The evidence is weak but indicates that levels of nurse staffing in the ED are associated with patients leaving without being seen, ED care time and patient satisfaction. Lower staffing is associated with worse outcomes. There remain significant gaps and in particular a lack of evidence on the impact of staffing on direct patient outcomes and adequate economic analyses to inform decisions about nurse staffing. Given that an association between nurse staffing levels and patient outcomes on inpatient wards has been demonstrated, this gap in the evidence about nurse staffing in EDs needs to be addressed.

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Accepted/In Press date: 8 July 2015
e-pub ahead of print date: 13 August 2015
Published date: November 2015
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 379161
URI: https://eprints.soton.ac.uk/id/eprint/379161
ISSN: 1472-0205
PURE UUID: 76be736c-ac3f-4b1d-b742-683469060650
ORCID for Alejandra Recio: ORCID iD orcid.org/0000-0003-2823-4573
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Jonathan Drennan: ORCID iD orcid.org/0000-0001-7365-4345

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Date deposited: 24 Jul 2015 13:04
Last modified: 06 Jun 2018 12:44

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Contributors

Author: Alejandra Recio ORCID iD
Author: Catherine Pope ORCID iD
Author: Chiara Dall'ora ORCID iD
Author: Peter Griffiths ORCID iD
Author: Jeremy Jones
Author: Robert Crouch

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