School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
School of Nursing and Midwifery, University College Cork, Cork, Ireland.
Int J Nurs Stud. 2024 May;153:104706. doi: 10.1016/j.ijnurstu.2024.104706. Epub 2024 Feb 1.
The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak.
We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach.
We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department.
Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings.
Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.
护士人力配置、技能组合与护理质量之间的关系在医疗和外科环境中已得到充分证实，然而，在急诊科中，这种关系的证据相对有限。已发表的研究表明，急诊科的护士人力配置水平较低通常与较差的结果相关，因此在急诊环境中的证据充其量是微弱的。
我们在 13 个电子数据库中搜索了截至 2023 年 12 月发表的可能符合条件的英文论文。如果研究报告了与急诊科护士人力配置相关的患者结局，则纳入研究。纳入的研究设计包括观察性、横断面、前瞻性、回顾性、中断时间序列设计、差异中的差异、随机对照试验或准实验研究以及对照前后研究。团队成员独立筛选标题和摘要。使用叙述性方法综合数据。
我们确定了 16 篇论文纳入；大多数研究（n=10/16）为观察性研究。回顾的证据表明，急诊科人力配置水平较差与患者等待时间延长、未得到诊治的患者比例增加以及住院时间延长有关。护士人力配置水平较低还与药物和治疗干预的时间延长以及急诊科内心脏骤停的风险增加相关。
总体而言，关于急诊科护士人力配置与患者结局之间的关联，仍然缺乏高质量的实证证据。然而，显然，较低的护士人力配置与可导致护理延迟和患者发生严重后果的不良事件相关。需要进行纵向研究，并开展考虑技能组合、其他人员配置级别和患者结局以及更广泛地理环境的关系的研究。
急诊科护士人力配置水平较低与患者接受治疗的延迟以及护理质量下降有关，包括未得到诊治的比例增加、接受治疗和药物的时间延迟以及心脏骤停。
