Problem: Though not empirically supported, the staffing approach in our Emergency Department (ED) did not seem to capture time staff responded to high acuity emergencies.
Measurement: FMEA, and Validated and reliable (face validity, content validity, and Kappa estimates) measurement tool.
Analysis: Inter-rater reliability was assessed. Data were collected over a two-week period. Descriptive statistics informed calculations of the impact of ED nurses leaving assignment on worked hours per patient Visit (wHPPV) and FTEs. Additionally, correlations, crosstabulations, and prediction models were used to analyze data further.
Implementation: We implemented a two-week data collection period using the nurse residents and not using the assigned nurse workforce. Issues included: a lack of experience in data collection by residents, emergencies causing residents to get pulled from data collection, need to educate team in interpretation and elevator pitch for stakeholder buy-in.
Results/Discussion: The tool was reliable with a Kappa of .9573. There were 704 instances of deployment during two-week period. There was an average of 18 high acuity events per day, and 50 staff responses per day, with an average of 2.8 staff responses per event.