Time Cost of Standardized Nursing Screens in the Emergency Department

INTRODUCTION: Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the time nursing spent conducting standardized nursing screens and calculate the corresponding time cost. METHODS: This was a prospective observational study of ED registered nurses (RN) performing triage assessments on adults presenting to the ED. A study author timed nurses while the RN asked five pre-selected questions from their current triage protocol. The time cost of each question was determined by multiplying the length of time spent asking the question each year by the mean hourly wage of RNs at the study hospital. (T/3,600) × V × S; T = mean time per question (in seconds); V = annual patient volume; S = mean hourly RN wage. RESULTS: We observed 200 triage assessments. During the triage assessments, 130 patients (65%) were asked about pneumococcal vaccine status; 161 (80.5%) about tetanus vaccine status; 184 (92%) about medication allergies; 172 (86%) about influenza vaccine; and 73 (36.5%) about recent travel. The mean time spent per question ranged from 4.37-6.26 seconds. The estimated annual time used to ask the five questions in the study ED is 590.73 hours, which equates to $20,675.50 in nursing costs per year. CONCLUSION: There are potential monetary and time costs of standardized screening questions in the ED. The values heavily impact time and cost efficiency in the ED and could be redirected to more pertinent patient care. The required screening questions often have an unclear utility on the care that the patient receives in the ED. Further studies are needed to determine cost effectiveness of required ED screenings.