Article Data

  • Views 669
  • Dowloads 160

Original Research

Open Access Special Issue

Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

  • Li-Heng Tsai1
  • Wei-Che Chien1
  • Chen-Bin Chen1,2
  • Shang-Li Tsai2,3
  • Chung-Hsien Chaou1
  • Yi-Ming Weng1,4
  • Chip-Jin Ng1
  • Chen-June Seak1,2
  • Shou-Yen Chen1
  • Chien-Hsiung Huang1
  • Shao-Yu Fang1
  • Chi-Chun Lin1,5
  • Cheng-Yu Chien1,5

1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou branch and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan

2Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan

3Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Taiwan

4Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan

5Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan

DOI: 10.22514/sv.2021.029 Vol.17,Issue 4,July 2021 pp.118-124

Submitted: 09 January 2021 Accepted: 01 February 2021

Published: 08 July 2021

*Corresponding Author(s): Cheng-Yu Chien E-mail: rainccy217@gmail.com

Abstract

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio.

Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA.

Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence.

Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence.

Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.


Keywords

Emergency department; Cardiac arrest; Crowding; Nursing staff


Cite and Share

Li-Heng Tsai,Wei-Che Chien,Chen-Bin Chen,Shang-Li Tsai,Chung-Hsien Chaou,Yi-Ming Weng,Chip-Jin Ng,Chen-June Seak,Shou-Yen Chen,Chien-Hsiung Huang,Shao-Yu Fang,Chi-Chun Lin,Cheng-Yu Chien. Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study. Signa Vitae. 2021. 17(4);118-124.

References

[1] Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Academic Emergency Medicine. 2011; 18: 1358-1370.

[2] Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Internal and Emergency Medicine. 2015; 10: 171-175.

[3] Nawar EW, Niska RW, Xu J. National hospital ambulatory medical care survey: 2005 emergency department summary. Advance Data. 2007; 386: 1- 32.

[4] Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf (Accessed: September 1, 2020).

[5] Ministry of Health and Welfare of Taiwan. National health insurance annual statistical 1997-2018. Available at: https://dep.mohw.gov. tw/DOS/mp-113.html (Accessed: September 1, 2020).

[6] Stang AS, Crotts J, Johnson DW, Hartling L, Guttmann A. Crowding measures associated with the quality of emergency department care: a systematic review. Academic Emergency Medicine. 2015; 22: 643-656.

[7] Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang L, Han W, et al. Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine. 2013; 61: 605-611.e6.

[8] Chiu I, Lin Y, Syue Y, Kung C, Wu K, Li C. The influence of crowding on clinical practice in the emergency department. The American Journal of Emergency Medicine. 2018; 36: 56-60.

[9] Chang Y, Shih H, Chen C, Chen W, Huang F, Muo C. Association of sudden in-hospital cardiac arrest with emergency department crowding. Resuscitation. 2019; 138: 106-109.

[10] Chen Q, Olsen G, Bagante F, Merath K, Idrees JJ, Akgul O, et al. Procedure-specific volume and nurse-to-patient ratio: implications for failure to rescue patients following liver surgery. World Journal of Surgery. 2019; 43: 910-919.

[11] Jansson MM, Syrjälä HP, Ala-Kokko TI. Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mor-tality: a prospective, single-center cohort study. Journal of Hospital Infection. 2019; 101: 257-263.

[12] Driscoll A, Grant MJ, Carroll D, Dalton S, Deaton C, Jones I, et al. The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2018; 17: 6-22.

[13] Valderrama AL, Fang J, Merritt RK, Hong Y. Cardiac arrest patients in the emergency department-National Hospital Ambulatory Medical Care Survey, 2001-2007. Resuscitation. 2011; 82: 1298-1301.

[14] Vancini-Campanharo CR, Vancini RL, de Lira CA, Andrade MD, Lopes MC, Okuno MF, et al. Characterization of cardiac arrest in the emergency department of a Brazilian university reference hospital: a prospective study. Indian Journal of Medical Research. 2016; 144: 552-559.

[15] Ng C, Yen Z, Tsai JC, Chen LC, Lin SJ, Sang YY, et al. Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system. Emergency Medicine Journal. 2011; 28: 1026-1031.

[16] Tsai L, Huang C, Su Y, Weng Y, Chaou C, Li W, et al. Comparison of prehospital triage and five-level triage system at the emergency department. Emergency Medicine Journal. 2017; 34: 720-725.

[17] McCarthy ML, Aronsky D, Jones ID, Miner JR, Band RA, Baren JM, et al. The emergency department occupancy rate: a simple measure of emergency department crowding? Annals of Emergency Medicine. 2008; 51: 15-24, 24.e1-2.

[18] Chaou C, Chen H, Tang P, Yen AM, Wu K, Hsiao C, et al. Traffic intensity of patients and physicians in the emergency department: a queueing approach for physician utilization. The Journal of Emergency Medicine. 2018; 55: 718-725.

[19] Chang AM, Lin A, Fu R, McConnell KJ, Sun B. Associations of emer-gency department length of stay with publicly reported quality‐of‐care measures. Academic Emergency Medicine. 2017; 24: 246-250.

[20] Shin TG, Jo IJ, Choi DJ, Kang MJ, Jeon K, Suh GY, et al. The adverse effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Critical Care. 2013; 17: R224.

[21] Reznek MA, Murray E, Youngren MN, Durham NT, Michael SS. Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding. Stroke. 2017; 48: 49-54.

[22] Kang J, Kim J, Jo YH, Kim K, Lee JH, Kim T, et al. ED crowding and the outcomes of out-of-hospital cardiac arrest. The American Journal of Emergency Medicine. 2015; 33: 1659-1664.

[23] Chisholm CD, Weaver CS, Whenmouth L, Giles B. A task analysis of emergency physician activities in academic and community settings. Annals of Emergency Medicine. 2011; 58: 117-122.

[24] Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety. Keeping patients safe: transforming the work environment of nurses. Washington (DC): National Academies Press (US). 2004.

[25] McHugh MD, Rochman MF, Sloane DM, Berg RA, Mancini ME, Nadkarni VM, et al. Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care. 2016; 54: 74-80.

[26] Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. The New England Journal of Medicine. 2002; 346: 1715-1722.

[27] Eriksson CO, Stoner RC, Eden KB, Newgard CD, Guise J. The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review. Journal of General Internal Medicine. 2017; 32: 686-696.

[28] Collis J. Adverse effects of overcrowding on patient experience and care. Emergency Nurse. 2010; 18: 34-39.

[29] Ramsey Z, Palter JS, Hardwick J, Moskoff J, Christian EL, Bailitz J. Decreased nursing staffing adversely affects emergency department throughput metrics. The Western Journal of Emergency Medicine. 2018; 19: 496-500.

[30] Cho S, June KJ, Kim YM, Cho YA, Yoo CS, Yun S, et al. Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. Journal of Clinical Nursing. 2009; 18: 1729-1737.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top