Browse > Article
http://dx.doi.org/10.22650/JKCNR.2020.26.3.395

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency  

Jung, Eun Hee (Department of Nursing, Seoul National University Hospital)
Cho, Sung-Hyun (College of Nursing.Research Institute of Nursing Science, Seoul National University)
Lee, Sang Lim (Department of Nursing, Seoul National University Hospital)
Choi, Min Jin (Department of Nursing, Seoul National University Hospital)
Kim, Sung Sook (Department of Nursing, Asan Medical Center)
Choi, Eun Kyung (Department of Nursing, Asan Medical Center)
Han, Kyeong Hwa (Department of Nursing, Ajou University Hospital)
Jeon, Mi Young (Department of Nursing, Ajou University Hospital)
Publication Information
Journal of Korean Clinical Nursing Research / v.26, no.3, 2020 , pp. 395-406 More about this Journal
Abstract
Purpose: The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. Methods: The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. Results: Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. Conclusion: Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.
Keywords
Patient Acuity; Dependency; Emergency Department; Nurse Staffing; Triage;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Parliament of Victoria (AU). Safe Patient Care(Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2018 [Internet]. Melbourne: State Government of Victoria(AU); 2018 [cited 2020 Sep. 28]. Available from: https://www.legislation.vic.gov.au/bills/safe-patient-care-nurse-patient-and-midwife-patient-ratios-amendment-bill-2018.
2 Mahmoudi H, Mohmmadi E, Ebadi A. Barriers to nursing care in emergency wards. Iranian Journal of Nursing and Midwifery Research. 2013;18(2):145-151.
3 Choi SH. A study on patient dependency in emergency medical centers [master's thesis]. Seoul: Yonsei University; 2018. p. 1-70.
4 Mollaoglu M, Celik P. Evaluation of emergency department nursing services and patient satisfaction of services. Journal of Clinical Nursing. 2016;25(19-20):2778-2785. https://doi.org/10.1111/jocn.13272   DOI
5 Kallberg AS, Ehrenberg A, Florin J, Ostergren J, Goransson KE. Physicians' and nurses' perceptions of patient safety risks in the emergency department. International Emergency Nursing. 2017;33:14-19. https://doi.org/10.1016/j.ienj.2017.01.002   DOI
6 Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care. 2007;45(12):1195-1204. https://doi.org/ 10.1097/MLR.0b013e3181468ca3   DOI
7 Aiken LH, Sloane DM, Cimiotti JP, Clarke SP, Flynn L, Seago JA, et al. Implications of the California nurse staffing mandate for other states. Health Services Research. 2010;45(4):904-921. https://doi.org/10.1111/j.1475-6773.2010.01114.x   DOI
8 Griffiths P, Ball J, Drennan J, Dall'Ora C, Jones J, Maruotti A, et al. Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies. 2016;63:213-225. https://doi.org/10.1016/j.ijnurstu.2016.03.012   DOI
9 Chan TC, Killeen JP, Vilke GM, Marshall JB, Castillo EM. Effect of mandated nurse-patient ratios on patient wait time and care time in the emergency department. Academic Emergency Medicine. 2010;17(5):545-552. https://doi.org/10.1111/j.1553-2712.2010.00727.x   DOI
10 Recio-Saucedo A, Pope C, Dall'Ora C, Griffiths P, Jones J, Crouch R, et al. Safe staffing for nursing in emergency departments: Evidence review. Emergency Medicine Journal. 2015; 32(11):888-894. https://doi.org/10.1136/emermed-2015-204936   DOI
11 National Law Information Center. Enforcement decree of the emergency medical service act [Internet]. Sejong: Korea Ministry of Health and Welfare. 2020 [cited 2020 Dec. 14]. Available from: http://www.law.go.kr/lsInfoP.do?lsiSeq=206263#0000
12 Cho SH, Hong KJ, Yoon HJ, Chang SJ, Choi KH, Park HJ, et al. Estimation of expected nursing hours based on patients' nursing care needs and a comparison with actual nursing hours in comprehensive nursing care wards. Journal of Korean Academy of Nursing Administration. 2020;26(4):365-377. https://doi.org/10.11111/jkana.2020.26.4.365   DOI
13 Cho SH, Song KJ, Park IS, Kim YH, Kim MS, Gong DH, et al. Development of staffing levels for nursing personnel to provide inpatients with intergrated nursing care. Journal of Korean Academy of Nursing Administration. 2017;23(2):211-222. https://doi.org/10.11111/jkana.2017.23.2.211   DOI
14 Alghamdi MG. Nursing workload: A concept analysis. Journal of Nursing Management. 2016;24(4):449-457. https://doi.org/10.1111/jonm.12354   DOI
15 Graff I, Goldschmidt B, Glien P, Klockner S, Erdfelder F, Schiefer JL, et al. Nurse staffing calculation in the emergency department-performance-oriented calculation based on the Manchester Triage System at the University Hospital Bonn. PLoS One. 2016;11(5):e0154344. http:/doi.org/10.1371/journal.pone.0154344   DOI
16 RCN Emergency Care Association, Faculty of Emergency Nursing. BEST-Baseline Emergency Staffing Tool [Internet]. London: Royal College of Nursing; 2013 [updated 2019 May 11; cited 2020 Oct 30]. Available from: https://www.rcn.org.uk/get-involved/forums/emergencycare-association/best-tool.
17 Hurst K. Selecting and applying methods for estimating the size and mix of nursing teams: A systematic review of the literature commisioned by the Department of Health [Internet]. Leeds: University of Leeds(UK), Nuffield Institute for Health; c2003 [cited 2020 Sep. 28]. Available from: https://www.who.int/hrh/tools/size_mix.pdf.
18 Wise S, Fry M, Duffield C, Roche M, Buchanan J. Ratios and nurse staffing: The vexed case of emergency departments. Australasian Emergency Nursing Journal. 2015;18(1):49-55. https://doi.org/10.1016/j.aenj.2014.08.001   DOI
19 Williams S, Crouch R. Emergency department patient classification systems: A systematic review. Accident and Emergency Nursing. 2006;14(3):160-170. https://doi.org/10.1016/j.aaen.2006.06.002   DOI
20 Kuriyama A, Urushidani S, Nakayama T. Five-level emergency triage systems: Variation in assessment of validity. Emergency Medicine Journal. 2017;34(11):703-710. https://doi.org/10.1136/emermed-2016-206295   DOI
21 Park JB, Lim TH. Korean Triage and Acuity Scale(KTAS). Journal of the Korean Society of Emergency Medicine. 2017; 28(6):547-551.
22 State of California, Department of Industrial Relations. California Code of Regulations [Internet]. Sacramento: State of California; [cited 2020 Oct 30]. Available from: https://www.dir.ca.gov/dlse/ccr.htm.
23 Boggatz T, Dijkstra A, Lohrmann C, Dassen T. The meaning of care dependency as shared by care givers and care recipients: A concept analysis. Journal of Advanced Nursing. 2007;60(5):561-569. https://doi.org/10.1111/j.1365-2648.2007.04456.x   DOI
24 Jones G. Measuring patient dependency in the emergency department. Nursing Standard. 2015;30(2):38-43. https://doi.org/10.7748/ns.30.2.38.e9249   DOI
25 Hurst K. Emergency Department(ED)/Accident and Emergency (A&E) department workload and staffing data collection information pack. King's Lynn(UK): Hurst Research Ltd; 2019.
26 Lavander P, Merilainen M, Turkki L. Working time use and division of labour among nurses and health-care workers in hospitals: A systematic review. Journal of Nursing Management. 2016;24(8):1027-1040. https://doi.org/10.1111/jonm.12423   DOI
27 Institute for Health Care Improvement (US). Percent of nurse time spent in direct patient care [Internet]. Boston: Institute for Health Care Improvement; c2020 [cited 2020 Oct 30]. Available from: http://www.ihi.org/resources/Pages/Measures/PercentN urseTimeSpentinDirectPatientCare.aspx