New ENA survey reports on over 1,600 EDs
Latest statistics on staffing, acuity, and ED services
The Emergency Nurses Association (ENA), in Park Ridge, IL, recently completed a study of 1,686 EDs throughout the nation for the third National Emergency Department Database Survey.
The EDs in the sample represent a wide diversity of geographic locations, community settings, facility ownership, and varying sizes of institutions, says K. Sue Hoyt, RN, MN, CEN, former president of ENA. The database sample ranged from the largest to smallest of the nation’s EDs. (See chart on size of responding facilities and chart of ED admissions to inpatient hospital, p. 128.) Here are some key findings:
About one-fourth of the EDs reported 10,000 or less patient visits per year. Slightly less than half of the EDs reported visits in the 10,001 to 30,000 per year range. Larger patient volumes of 30,001 to 50,000 visits per year (18%) and over 50,000 visits per year (8%) were also reported.
• Patient acuity.
Between 1% and 10% of the ED patient population were emergent care patients in one-third of the EDs. Another third reported that between 11% and 20% of their patients were seen for emergent care problems. Another 14% of the EDs indicated that 21% to 30% of their patients were seen for emergent conditions.
Violence-related visits have increased in 45% of the EDs. In contrast, alcohol-related visits and illegal drug-related visits have not changed in about one-half of the EDs.
• New construction or remodeling.
About an equal number of ED anticipated construction within the next two years (45%) as those with no construction planned (41%).
The remaining EDs (14%) expected changes to their physical plant within the next three to 10 years.
• Computerization.
The activities that were computerized in more than 25% of the EDs included: patient registration (89%), order entry (68%), charge capture (50%), management reports (50%), and computerized medical records.
More recent computer applications for patient tracking (29%) and discharge instructions (31%) were available in EDs.
The percentage of EDs using computerized systems for those seven activities increased between 1% and 7% between 1996 and 1997, the last year for which figures are available.
When patient registration was not computerized, there were four types of institutions that used paper/manual systems more than other institutions. These facilities were rural, state or local government facilities, small institutions, and small EDs.
• Clinical documentation.
Computer applications for clinical documentation were present in some EDs but is still very limited. Medical assessments (14%), diagnoses (12%), interventions (10%), and outcomes (12%) were computerized in less than 15% of the EDs.
Nursing assessments were rarely documented using computerized systems. Nursing diagnosis was the information that was most frequently collected but not documented in EDs (6%).
Registration, order entry, charge capture, and management reports were computerized more often, with patient tracking and discharge instructions showing an increase of 4% and 5% respectively.
• Staff.
The number of nurse managers increased as the size of the ED visits increased. The FTEs for nurse managers ranged from zero to 11, with the most common number being one manager per ED. Only EDs with greater than 100,000 visits reported a mean of three nurse managers.
Nursing personnel in specialty roles who worked each week in the ED included staff development educators (25%), trauma coordinators (22%), nursing faculty (12%), clinical nurse specialists (9%), nurse practitioners (12%), case managers (13%), nurse researchers (2%). (See chart on EDs that reported hiring staff nurses, above.)
In comparison to the 89% of EDs that hired staff nurses, 77% also reported that there was no downsizing of staff nurses in their institution. Staff nurses were downsized in 11% of the institutions.
The percent of EDs that reported downsizing staff nurses increased to 15% in 1996 from 9% in 1995, but decreased to 12% in 1997.
• Specialty services.
Observation care flexible beds were used in 27% of the EDs, with 1-3 beds the most frequent response. Observation care adult beds were used in 10% of the EDs. Observation units have remained about the same in 1997 (27%) and 1996 (26%).
Fast-track flexible beds were used in 38% of the EDs.
Specialty beds reported were obstetrics/gynecology (69%), cardiac (65%), trauma (63%), orthopedic (53%), isolation (48%), decontamination (32%), respiratory (31%), psychiatric (31%), and burn (17%).
Specialty beds are up
Compared to 1996 data, there was an increased percentage of the 1997 EDs reporting beds in all specialty bed categories, from 1% to 5%.
Specialty services provided by the EDs included: rape intervention (35.5%), pediatrics (25.6%), trauma programs (25%), hospital-based EMS programs (24%), mental health centers (20%), chest pain centers (18%), urgent care centers (17%), toxicology poison
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