title: The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times.
abstract: The aim of our study was to investigate the impact of a new organization of our emergency department (ED) on patients' mortality and management delays.
  
  
  
  The ED segmentation consisted of the development of a new patient care geographical layout on a pre-existing site and changing the organization of patient flow. It took place on May 10, 2012. We did a before-after study in the ED of a university hospital, "before" (winter 2012) and "after" (summer 2012) reorganization by segmentation into sectors. All ED patients were included.
  
  
  
  Eighty-three thousand three hundred twenty-two patient visits were analyzed, 61,118 in phase "before", 22,204 during the phase "after". The overall inpatient mortality was 1.5 % during summer 2011 ("before" period), 1.8 % during winter 2012 ("before" period), 1.3 % during summer 2012 ("after" period) period (summer 2012 vs. winter 2012, OR = 0.72; 95 % CIs [0.61, 0.85], and summer 2012 vs. summer 2011, OR = 0.85; 95 % CIs [0.72, 0.99]). The mean (SD) time to first medical contact was 129 min (±133) during winter 2012 and 104 min (± 95) during summer 2012 (p < .05).
  
  
  
  Our study showed a decrease in mortality and improvement in time to first medical contact after the segmentation of our ED and nursing staffing increase, without an increase in medical personnel. Improving patient care through optimizing ED segmentation may be an effective strategy.
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France. pierre.geraud.claret@gmail.com.|EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France. pierre.geraud.claret@gmail.com.
authors.forename: Pierre-Géraud
authors.initials: PG
authors.lastname: Claret
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Olive
authors.affiliation: Department of Biostatistics, Clinical Research, Clinical Epidemiology, and Public Health, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Demattei
authors.affiliation: Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre and The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.|Montpellier-Nîmes University, 2 rue École de Médecine, 34060, Montpellier, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohendy
authors.affiliation: EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, 34093, Montpellier, France.|Department of Biostatistics, Clinical Research, Clinical Epidemiology, and Public Health, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.|Montpellier-Nîmes University, 2 rue École de Médecine, 34060, Montpellier, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Landais
authors.affiliation: Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France.|Montpellier-Nîmes University, 2 rue École de Médecine, 34060, Montpellier, France.
authors.forename: Jean Emmanuel
authors.initials: JE
authors.lastname: de la Coussaye
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D008297:Male; D009740:Nursing Staff / Q000600:supply & distribution*; D017748:Time Management
keywords: Emergency service; Hospital; Nursing staff; Organizations