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Ya, it's that link between ESI and patient acuity after reaching an ER bed that needs to be determined. How would you assess workload and then estimate the number of nurses needed to cover it.

Thanks for sharing Gary, I totally agree with you and in California the nurse to patient ratio is mandated so there is no need for the ED to justify FTEs or to accrediting bodies as why this ratio was followed. In our case we need to justify ( evidence based) why we chose to give 1 nurse 3 or 4 ESI 3 patients. On the other hand I also agree about the charge nurse jumping in and making changes yet wouldn't it be great if there was a tool that guide them how to do it ?

Yes we are using ESI, yet an ESI lvl does not really reflect the acuity of the patient once admitted to an ER bed. Assuming that it does how would you decide on the nurse to patient ratio example 1 nurse to 3 patients with ESI 3.

This is surly unsafe, 1:14 patients at the same time with high acuity patients, did you raise your concern to the nurse manager ? or administration ?, I know in some states like California the nurse to patient ratio in the ED is 1:4 and 1:1 or 1:2 depending on criticality. I am still not able to figure out how this ratio is decided ( for sure the less number of patient you have the better care you can provide) but how is a maximum number of ED patients chosen and to what acuity ? do we continue using the triage acuity for these patients ? how do we classify them ? if we are able to answer these questions I believe we can present data that the administration will have to accept to change the ratio.

With START you identify green tagged patients by the asking : Any one that can stand up and walk to do that, if your patient was able to understand this statement then they are not confused thus the green tag. A confused patient will remain in his/her place and further evaluation will be required in order to rule out traumatic brain injury and that is done by asking simple questions ( date, time, name.....

The literature suggest a 1:4 patient ratio in the Emergency Room, with no mention about their acuity, Triage sets the initial acuity for priority in bed allocation yet this does not really translate into the acuity of the patient once inside. How would you best evaluate the acuity of your patient once on the ER bed and thus allocate the nurse to patient ratio ?