Study | Country | Design | Number of EDs | Comparisons | Outcome | Key results | Patients seen | Internal validity | External validity |
---|---|---|---|---|---|---|---|---|---|
Green et al19 | USA | Prospective Observational | 1 | Workload as defined by nurse-patient ratios | Staff absenteeism | Failure to incorporate absenteeism as an endogenous effect results in understaffing. Nurse absenteeism is exacerbated when fewer nurses are scheduled for a particular shift. No quantitative results were reported | Not stated | – | − |
Harris and Sharma21 | Aus | Retrospective Observational | 38 | Annual average of nurses, physicians and beds at hospital level | Patient care time in the ED | A 1% change in the mean number of nurses (from 998 to 1008) is associated with a 2.38% fall in waiting time (from 396 min to 3871/49 min) assuming all other variables remain at their mean values. | Not stated | – | + |
Hobgood et al20 | USA | Prospective Observational | 1 | Workload (nurse-patient ratio ED acuity index) | Task allocation | RNs spent 25.6% of their time performing direct patient care; 48.4% on indirect patient care; 6.8% on non-RN care and 19.1% on personal time. The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98. | 60 000 | – | − |
Sinclair et al18 | UK | Before and after | 2 | Prior to and following the introduction of a specialist psychiatric nursing service | Waiting times Onward referral Repeat attendance Patient satisfaction Staff views | Average waiting times at each hospital shortest during the intervention period. No significant differences between preintervention and intervention periods at either site (hospital 1, p=0.763; hospital 2, p=0.076). Significant difference in onward referral patterns between intervention and non-intervention periods of the study at both sites (hospital 1, χ2=28.8, p=0.001; hospital 2, χ2=25.3, p=0.01). Levels of satisfaction recorded were high for all patients with no significant differences between intervention and non- intervention periods. | Dept: 1=55 000 Dept: 2=70 000 | – | − |
ED, emergency department.