The Influence of Staffing on Patient Experiences in the Emergency Department

Emergency Departments (EDs) are often the first point of contact for patients when they interact with the health care system. Across the country, EDs are associated with the provision of low standards of care due to patients having to wait for extended periods before receiving treatment. These long waits result in the provision of suboptimal care since the EDs struggle with inadequate staffing and are often overwhelmed by the patient volumes that they receive. Lack of access to specialist staff further degrades the situation and increases the time that some patients spend before receiving treatment. Lack of proper care often results in low patient satisfaction rates and some patients even leave without receiving any attention from emergency room staff. Staff density and optimization, therefore, have significant effects on the efficiency of ED processes as well as the standards of care that patients receive when they visit the department.

Long waiting times in the ED have significant negative implications for the department’s efficiency as well as the quality of care that patients receive. These waiting times stem from understaffing in the ED, inefficiencies in ED communication channels, slow lab analyses, and delays in transferring patients to inpatient care (Sayah, Rogers, Karthik, Kingsley-Rocker, & Lobon, 2014, p. 2). The lack of specialists in the ED also contributes to long waiting times as patients wait for expert opinions on their complaints (Sayah et al., 2014 p. 2). In 2010, for example, only 48% of EDs attended to patients within 6 hours of entering the ED in search of treatment (Sayah et al., 2014 p. 1). Therefore, more than half of all ED patients in the country had to wait more than 6 hours before receiving treatment. These figures indicate that EDs across the country are currently highly inefficient and that the subsequent long wait times result in patients receiving inadequate care.

The implementation of the Affordable Care Act means that health institutions will have to contend with increased patient volumes as more people seek access to health care services. The health environment in the country will, therefore, deteriorate even further if EDs maintain their current staff numbers and internal processes. To counteract this scenario, EDs can increase their reception staff and reduce bed segregation to increase the number of patients that they can concurrently attend to (Sayah et al., 2014 p. 3). Nurses and physicians can also share roles such as diagnosis and referral to inpatient care to reduce bottlenecks in patient diagnosis and admission (Sayah et al., 2014 p. 4). This scenario will require nurses to offer precise diagnoses that physicians and specialists can refer to when receiving inpatient cases. Studies indicate that when EDs implement this staff optimization model, they can treat patients within as few as 30 minutes of their arrival even in high patient volume scenarios (Sayah et al., 2014 p. 4).

EDs across the country currently lack the staff numbers and optimization processes needed to handle the patient volumes that they receive. The result is long waiting times for patients and the provision of inadequate care in EDs, which in turn reduces patients’ satisfaction with the care provided in the EDs. The Affordable Care Act increases access to medical insurance, and patient volumes in the ED will only increase as time progresses. EDs must, therefore, avoid carrying forward past inefficiencies to prevent the situation from escalating even further. Increasing staff volumes and optimizing ED processes is a method that has the potential to reduce patient waiting times and increase the quality of care that patients receive. The resultant increase in the quality of care also has the potential to increase patients’ satisfaction with the care that EDs provide.


Sayah, A., Rogers, L., Karthik, D., Kingsley-Rocker, L., & Lobon, L. F. (2014). Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care. Emergency Medicine International, 1-8.

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