title: Emergency nursing workload and patient dependency in the ambulance bay: A prospective study.
abstract: OBJECTIVE
  The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload.
  
  
  BACKGROUND
  The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time. The profile of these patients and on the related nursing workload is not well known.
  
  
  METHODS
  A prospective observational study design based upon a convenience sample of patients was conducted over a randomly selected four-week period. Nursing workload was assessing using the Jones Dependency Tool. A modified Work Observation Method By Activity Timing technique was used to estimate direct nursing care time.
  
  
  RESULTS
  Of 4068 presentations to ED, 640 (16%) occupied the ambulance bay following triage, of which the majority (n=408; 64%) had arrived by ambulance. Of those occupying the ambulance bay 205 (32%) were evaluated using the JDT. The majority of patients had potentially life-threatening symptoms (ATS 3, n=424; 66%), were moderately dependent (n=134; 65%), and consumed approximately 152.1h of direct nursing care time. A large proportion of direct nursing care time was spent on patient reassessment (60.4h) and pain management (29.6h). Patients occupying the ambulance bay had an average ED length of stay of 5.6h (4.6h), of which 1.8h (SD 1.8h) was spent delayed in the ambulance bay.
  
  
  CONCLUSIONS
  Early detailed assessment and symptom management of patients occupying the ambulance bay is extensively undertaken by emergency nurses. The frequency and number of patients off-loaded into non-clinical areas is not currently monitored or reported upon. This study has demonstrated that patients managed in the ambulance bay consume large amounts of nursing resources, commonly require acute level care and hospital admission.
authors.affiliation: Prince of Wales Hospital Emergency Department, Faculty of Health, University of Technology, Sydney, Australia. Electronic address: wayne.varndell@health.nsw.gov.au.
authors.forename: Wayne
authors.initials: W
authors.lastname: Varndell
authors.affiliation: Prince of Wales Hospital Emergency Department, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ryan
authors.affiliation: Prince of Wales Hospital Emergency Department, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Jeffers
authors.affiliation: Prince of Wales Hospital Emergency Department, Australia.
authors.forename: Nadya
authors.initials: N
authors.lastname: Marquez-Hunt
mesh_terms: D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D016529:Emergency Nursing / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*
keywords: Ambulance bay; Dependency; Emergency department; Workload