The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings. Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.

中文翻译：

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急诊科护士配备与护理质量之间的关联：系统评价

护士人员配置、技能组合和护理质量之间的关系在医疗和外科环境中已经得到很好的确立，但是，在急诊科中这种关系的证据相对有限。已发表的文章指出，急诊科护士配备水平较低通常与较差的结果相关，其结论是，急诊室的证据充其量是薄弱的。我们检索了 13 个电子数据库，寻找截至 2023 年 12 月以英文发表的可能符合条件的论文。如果研究报告了与急诊科护士人员配置相关的患者结果，则纳入研究。观察性、横断面、前瞻性、回顾性、间断时间序列设计、双重差分、随机对照试验或准实验研究以及研究前后对照研究设计均考虑纳入。团队成员独立筛选标题和摘要。使用叙述方法合成数据。我们确定了 16 篇论文纳入；大多数研究（n = 10/16）是观察性的。审查的证据表明，急诊科内人员配备水平较差与患者等待时间增加、未就诊而离开的患者比例较高以及住院时间延长有关。护士人员配备水平较低也与药物和治疗干预时间的增加以及急诊科内心脏骤停的风险增加有关。总体而言，关于急诊科护士人员配置与患者预后之间关系的高质量实证证据仍然有限。然而，很明显，护士人员配备水平较低与不良事件有关，可能导致延迟为患者提供护理并造成严重后果。需要进行纵向研究，并考虑与技能组合、其他人员配置等级和患者结果以及更广泛的地理环境之间的关系。急诊科护士人员配备水平较低与患者接受治疗的延误和护理质量差有关，包括失踪人数增加、获得治疗和药物的延误以及心脏骤停。