Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department

Joo Hyun Lee; Sung-Hyun Cho

doi:10.11111/jkana.2018.24.2.107

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Lee and Cho: Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department

Original Article

J Korean Acad Nurs Adm 2018;24(2):107-117.

Published online: 17 March 2018

DOI: https://doi.org/10.11111/jkana.2018.24.2.107

Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department

Joo Hyun Lee¹, Sung-Hyun Cho^2,

¹College of Nursing, Seoul National University

²College 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

Received 10 October 2017 Revised 26 December 2017 Accepted 26 December 2017

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.

Keywords: Crowding, Staffing, Emergency nursing, Pneumonia, Timeliness

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Figure 1.

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

Table 1.

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

Table 2.

Emergency Department Crowding and Nurse Staffing on 105 Shifts

Variables	Day shift	Evening shift	Night shift	Overall
Variables	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.

Table 3.

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

Table 4.

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

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