The impact of the 23-hour patient on nursing workload.

Decreasing length of in-patient stay and increasing the number of outpatient procedures being performed has led to the creation of the 23/24-hour observation patient. In this study, the authors show that the addition of observation patients to aggregate workload data causes a meaningful staffing deficit 60-90% of the time in three out of four clinical areas studied. The authors explore the statistical impact on staffing of the addition of observation patients to aggregate inpatient data and provide several strategies for staffing.