Nurse Staffing Calculation in the Emergency Department - Performance-Oriented Calculation Based on the Manchester Triage System at the University Hospital Bonn

Background: To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe. Material and Methods: Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS), taking into account specific workload fluctuations (50th-95th percentiles). Results: Patients classified to the MTS category red (n = 35) required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118), nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181), 40.95 min, while the two MTS categories with the least acute patients, green (n = 129) and blue (n = 40) required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010) emergency patients, 67–123 emergency patients (50–95% percentile) per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1. Conclusion: Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.