Patient safety and staffing in emergency departments

File(s)
Date
2009-04-10Author
Ecklor, Nekole
Advisor(s)
Collier, Jill
Metadata
Show full item recordAbstract
The purpose of this study was to investigate and describe nurse staffing
methods, nurse skill mix, and patient safety in emergency departments (EDs) in order to
address the question: How does nurse staffing impact patient safety in EDs? Although
studies have revealed an association between nurse staffing and patient safety for
inpatient populations, there is limited research on the relationship between nurse staffing
methods, nurse skill mix, and patient safety in EDs.
The question was evaluated by examining the ED as a system using Katz and
Kahn's Open Systems Theory. In this framework, patients enter the ED department
(system) and their outcome (patient safety) is influenced by nurse staffing (throughput).
A descriptive cross-sectional design was used to investigate nurse staffing
methods, nurse skill mix, and the impact on patient safety. The setting was EDs in the
state of Wisconsin that were listed with the American Hospital Association (AHA). All ED
managers on the AHA's list received the Emergency Department Survey (EDS). The
EDS is a 12-item survey that investigated the nurse staffing method, nurse skill mix, and
measured patient safety by examining the frequency of patient safety incidents in EDs.
Fifty-seven usable surveys were returned out of the 115 distributed. With a research
standard of 95% confidence level, 89 surveys were needed to produce meaningful
findings.
The statistical analyses used to analyze the collected data and answer the
research question were descriptive, analysis of covariance (ANCOVA), qualitative
analysis, and multiple regressions. Findings from the statistical analysis are: (a)
Industrial engineering method of nurse staffing had a higher level of errors than other
methods; (b) Emergency medical technician-paramedics (EMT-P) were four times more
likely to have a correlation of medication errors and sentinel events combined; (c)
Registered nurses (RNs) have an inverse association with a positive impact on patient
safety; (d) Incorrectlabeling comprised 13.5% of total errors; (e) The largest category in
the variable of patient safety was elopement, with 40% of reported errors; (f) Patient falls
had an inverse correlation. with licensed practical nurses (LPNs) and EMT-Ps; (g)
Elopement had a positive correlation with RNs and EMT-Ps and an inverse correlation
with LPNs; (h) Incorrect identification was inversely correlated with LPNs and unlicensed
assistive personnel (UAPs) and positively correlated with EMT-Ps; (i) Incorrect specimen
labeling was inversely correlated with LPNs and EMT-Ps.
Subject
Nurse and patient
Emergency Nursing -- organization & administration
Nursing, Safety measures
Nursing Staff, Hospital
Permanent Link
http://digital.library.wisc.edu/1793/34330Type
Thesis
Description
A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science - Nursing - Family Nurse Practitioner
--University of Wisconsin-Oshkosh, 2008