Associations Between Direct Care Nursing Characteristics and Emergency Department Length of Stay: Findings From an Exploratory Retrospective Study

Introduction: Emergency department length of stay has meaningful consequences for emergency care quality, patient safety, and health care costs. Direct care emergency nurses are integral to the management of patient throughput, but little is known about the impact of nursing characteristics on emergency department length of stay. Methods: An exploratory retrospective study was conducted at a community emergency department. One year of patient records was selected to include all arrivals to an emergency bed within the first 4 hours of major nursing shifts. Hourly department census levels and staffing data were retrieved and collated with patient records. Data were analyzed using multivariable models to examine associations among nursing characteristics, patient characteristics, department census, and emergency department length of stay. Generalized linear mixed models were fit to account for nurse-level clustering. Results: A total of 12,513 patient encounters and 92 nurses were included. ED length of stay varied significantly according to patient sex, age, chief complaint, triage score, discharge service, and department census. Nurses with advanced certification and postgraduate education were associated with emergency department lengths of stay that were 10% to 14% shorter, respectively, than uncertified and associate-prepared nurses. Nurses’ experience and traveler status had less impact on emergency department length of stay. Discussion: This exploratory study provides preliminary evidence of an association between the characteristics of direct care nurses and the speed of emergency patient flow. Additional research is needed to replicate these findings and further examine relationships between emergency nursing characteristics and patient flow metrics.