J Korean Clin Nurs Res.  2020 Dec;26(3):395-406. 10.22650/JKCNR.2020.26.3.395.

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

Affiliations
  • 1Nursing Director, Department of Nursing, Seoul National University Hospital ․ Chairman, Korea Emergency Nurses Association, korea
  • 2Professor, College of Nursing ․ Research Institute of Nursing Science, Seoul National University, korea
  • 3Nursing Director, Department of Nursing, Seoul National University Hospital, korea
  • 4RN, Department of Nursing, Seoul National University Hospital, korea
  • 5Unit Manager, Department of Nursing, Asan Medical Center, korea
  • 6Advanced Practice Nurse, Department of Nursing, Asan Medical Center, korea
  • 7Nursing Director, Department of Nursing, Ajou University Hospital, korea
  • 8Unit Manager, Department of Nursing, Ajou University Hospital, korea

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.

Keyword

Patient Acuity; Dependency; Emergency Department; Nurse Staffing; Triage
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