Shorter Emergency Department Boarding Times in Hospitals With Better Nurse Staffing

INTRODUCTION: Boarding occurs when a patient is admitted to the hospital but remains in the emergency department until an inpatient bed is available. No previous evidence establishes a relationship between hospital nurse staffing and emergency department boarding times. This study fills this gap. METHODS: This was a cross-sectional study of 335 hospitals in Florida, New Jersey, and Pennsylvania. Using staffing data from 1367 medical-surgical nurses in the RN4CAST-US 2016 survey, hospitals were categorized as having worse (≥5:1) than better (<5:1) patient-to-nurse staffing ratios. The American Hospital Association provided data on hospital characteristics. Hospital emergency department patient boarding times were derived from the Centers for Medicare and Medicaid Services Compare timely and effective care files. Hospital-level linear regression models using a doubly robust propensity score weighting approach were used to evaluate the relationship between nurse staffing and boarding times. RESULTS: Most study hospitals had worse (n = 286) than better (n = 49) patient-to-nurse staffing ratios. Mean boarding times were longer in the worse-staffed hospitals than the better-staffed hospitals (128 vs 108 minutes; P = .01). These findings persisted in the propensity score weighted models (127 vs 108 minutes; P = .03) and the doubly robust models (128 vs 108 minutes; P = .009). DISCUSSION: This study establishes a baseline understanding of the relationship between hospital nurse staffing levels and patient boarding times, providing a foundation for evaluating changes over time. Safe nurse staffing levels are a modifiable lever to reduce emergency department crowding through decreasing patient boarding times.