JKANA Journal of Korean Academy of Nursing Administration J Korean Acad Nurs Adm 1225-9330 2288-4955 Korean Academy of Nursing Administration 10.11111/jkana.2018.24.2.107 jkana-24-107 Original Article Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department LeeJoo Hyun1 ChoSung-Hyun2 College of Nursing, Seoul National University College of Nursing, Research Institute of Nursing Science, Seoul National University Corresponding author: Cho, Sung-Hyun College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8821, Fax: +82-2-765-4103, E-mail: sunghcho@snu.ac.kr 032018 17032018 242 107117 10102017 26122017 26122017 Copyright © 2018 Korean Academy of Nursing Administration 2018 This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose:

This study was conducted to identify the effect of crowding and nurse staffing on time to antibiotic administration for pneumonia patients in an emergency department (ED).

 Methods:

The sample included pneumonia patients visiting an ED from November 1, 2014 to February 28, 2015. Crowding was measured using ED occupancy rate, nurse staffing was measured as total length of stay per nurse and number of patients per nurse and the time duration was measured for the following processes: from patient arrival to prescription, from prescription to blood culture and antibiotic administration, and from blood culture to antibiotic administration. Data collected from the electronic medical records were analyzed using multivariate analyses.

 Results:

The mean times from arrival to antibiotics administration, from prescription to antibiotic administration, and from blood culture to antibiotic administration were 128.31, 47.29, and 15.60 minutes, respectively. Crowding, nurse staffing, work experience of the nurse and severity of the patient influenced the time duration of each process from patient arrival to antibiotic administration.

 Conclusion:

The results reveal that crowding and nurse staffing affect length of time to antibiotic administration in pneumonia patients. Guidelines for safe nurse staffing in ED are required to improve patient outcomes.

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Clinical process and time durations from patient arrival to antibiotic administration in patients with pneumonia.

Patient and Nurse Characteristics

Variables Characteristics Categories n (%) or M±SD
Patients (N=124) Gender Female 51 (41.1)
Male 73 (58.9)
Age (year) 68.2±15.2
Emergency Severity Index Level 1 17 (13.7)
Level 2 16 (12.9)
Level 3 91 (73.4)
Shift when antibiotic being administered Day 47 (44.8)
Evening 41 (39.0)
Night 17 (16.2)
Medical specialty Respiratory 58 (46.8)
Emergency 51 (41.1)
Other 15 (12.1)
Length of stay per patient visit (hour) 18.17±20.42
Nurses (N=60) Work experience in the current hospital (year) 3.42±3.47

Emergency Department Crowding and Nurse Staffing on 105 Shifts

Variables Day shift Evening shift Night shift Overall
M±SD M±SD M±SD M±SD
Number of patient visits during shift 81.04±13.49 62.51±15.52 32.18±5.34 65.90±21.71
Number of discharges during shift Number of patients during shift 48.15±12.12 144.98±19.37 88.00±15.74 154.39±21.28 34.53±5.61 100.06±15.80 61.50±25.33 141.38±27.02
Total length of stay per shift (hour) 651.87±138.45 619.48±130.38 550.83±130.68 622.87±137.38
Average length of stay per shift (hour)* Number of nurses worked on shift 4.46±0.55 12.85±1.00 3.98±0.48 14.62±0.86 5.43±0.57 12.82±0.39 4.43±0.72 13.54±1.23
Crowding
Emergency department occupancy rate (%)† 167.00±36.78 170.80±37.24 136.33±31.57 164.02±37.35
Nurse staffing
Total length of stay per nurse (hour)‡ 50.50±8.86 42.16±7.62 42.95±10.03 46.02±9.43
Number of patients per nurse§ 11.30±1.39 10.53±1.12 7.80±1.21 10.43±1.74

*Total length of stay per shift/number of patients during shift;

Total length of stay per shift/ (number of beds × 8 hours);

Total length of stay per shift/number of nurses worked on shift;

Number of patients during shift/number of nurses worked on shift.

Time Durations From Patient Arrival to Antibiotic Administration by Emergency Severity Index (N=124)

Variables Time 1 Time 2 Time 3 Time 4 Time 5
Arrival to blood culture prescription Blood culture prescription to obtainments Blood culture obtainments to antibiotic administration Antibiotic prescription to administration Arrival to antibiotic administration
M±SD Median M±SD Median M±SD Median M±SD Median M±SD Median
Severity
Level 1 55.12±52.13 13 39.06±23.45 33 17.76±21.00 9 45.88±26.87 35 72.94±32.69 74
Level 2 79.06±79.24 41 37.31±16.76 36 11.88±11.94 8.5 43.06±16.34 41.5 93.13±35.36 89
Level 3 69.48±112.43 31 46.04±30.12 38 15.85±19.13 10 48.30±28.85 44 144.84±106.85 114
Overall 68.75±102.02 30 43.96±27.98 36 15.60±18.58 9.5 47.29±21.18 43.5 128.31±97.12 103

Factors related to Time Durations From Patient Arrival to Antibiotic Administration

Variables Time 3 Time 4 Time 5
Blood culture obtainments to antibiotic administration Antibiotic prescription to administration Arrival to antibiotic administration
Coefficient p Coefficient p Coefficient p
Model 1 Emergency department occupancy rate (%) 0.11 .017 0.16 .016 0.34 .146
Work experience of the nurse (year) -1.21 .020 -1.54 .043 2.38 .371
Emergency Severity Index (vs. Level 3)
Level 1 5.65 .250 2.67 .711 -70.92 .006
Level 2 -5.22 .289 -7.04 .331 -54.81 .033
Model 2 Total length of stay per nurse (hour) 0.26 .045 0.46 .042 1.18 .020
Work experience of the nurse (year) -1.15 .029 -1.45 .036 2.58 .333
Emergency Severity Index (vs. Level 3)
Level 1 5.00 .335 2.02 .766 -71.45 .006
Level 2 -4.82 .317 -6.67 .336 -54.59 .034
Model 3 Number of patients per nurse 0.82 .396 2.18 .043 -0.97 .846
Work experience of the nurse (year) -1.17 .027 -1.50 .032 2.54 .344
Emergency Severity Index (vs. Level 3)
Level 1 4.30 .366 1.10 .880 -74.71 .003
Level 2 -4.54 .388 -6.54 .374 -50.89 .049