Association of Emergency Department and Medical-Surgical Nurse Staffing on Patient Departures Against Medical Advice.
K Jane Muir, Daniela Golinelli, Karen B Lasater and 4 others
PMID 41575406WHAT IT FOUND
Each additional patient per ED nurse was associated with a higher likelihood of patients leaving against medical advice.
Each additional medical-surgical patient was associated with higher likelihood as well. Staffing load may contribute to patients leaving before recommended care.
Key findings
01Each additional patient per ED nurse was associated with higher adjusted odds of an AMA departure (OR 1.19, 95% CI 1.09 to 1.31).
02Each additional patient per medical-surgical nurse was associated with higher adjusted odds of an AMA departure (OR 1.55, 95% CI 1.33 to 1.81).
03Sensitivity analyses supported an increase in patient AMA departures for each additional patient added to a nurse's workload.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is cross-sectional, so it cannot show that higher staffing caused more AMA departures. The nurse survey and patient visit dates could not be linked. The main data did not link patient visits to the same person, and patients could present multiple times during the study year. The outcome included patients who left against medical advice or discontinued care, so it is unknown whether an official AMA form was signed. Patients with mental, behavioral, and neurodevelopmental disorders were excluded, so the findings do not cover those presentations. The staffing measure came from nurses' reports of their last shift, averaged to the hospital level. The hospital staffing measure had moderate reliability.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read the higher odds as proof that nurse staffing changes will reduce AMA departures. The study is cross-sectional, so causal linkages cannot be inferred.