The effect of a nursing strike on emergency department operational metrics.

BACKGROUND: In July of 2017, after more than 15 months of negotiations, an academic teaching hospital in Boston failed to reach an agreement on the terms of contract renewal with its nursing union resulting in a strike. Replacement nurses were hired by the hospital to fulfill nursing duties for five days. OBJECTIVES: This study aims to measure the effects of this nursing strike on the patients seen in the emergency department (ED) by examining operational metrics before and during the strike. METHODS: Retrospective analysis of patient visits occurring for the five days of the strike (July 12-16, 2017) compared with the analogous five-day period immediately preceding that of the strike (July 5-9, 2017). RESULTS: During the strike, ED volume decreased by 23.6% (691 vs. 528 visits), and the decrease was more pronounced for adult vs. pediatric visits. There were no differences in patient sex, race/ethnicity or age groups. EMS transports decreased by 49.1% (171 vs. 87 transports). Although patient dispositions were similar in both periods, length of stay decreased for discharged patients (median 204 vs 178 minutes, p=0.01), and did not change significantly for admitted patients (median 322 vs. 320 minutes, p=0.33). There was one patient death in each of the periods. CONCLUSION: Although rare, nursing strikes do occur. These data may be useful for hospitals preparing for a strike.

Emergency department patient knowledge, opinions, and risk tolerance regarding computed tomography scan radiation.

BACKGROUND: Computed tomography (CT) scanning use for emergency department (ED) patients has increased exponentially since its inception. STUDY OBJECTIVES: This study aimed to determine what patients view as the risk of radiation from CT scans, their risk tolerance and preference for alternative testing, and their opinions about informed consent and malpractice regarding CT scans. METHODS: A 25-question survey was administered to a random convenience sample of ED patients aged ≥ 18 years by trained research associates. RESULTS: There were 487 patients approached to be surveyed; 78 patients were excluded, leaving 409 patients (84.0%) responding. Mean patient age was 40.5 (standard deviation [SD] 16.8) years, and 51.5% were female. Three hundred ninety of 409 (95.4%) believed doctors should explain the risks and benefits of CT, and 316/409 (77.3%) thought an informed consent form should be signed. One hundred seventy-nine of 409 (43.8%) patients recognized that there was more radiation from a CT scan than a single chest x-ray study. Three hundred twenty-four of 409 (79.2%) preferred CT angiography over lumbar puncture to exclude subarachnoid hemorrhage. To diagnose appendicitis, 199/409 (48.7%) preferred an ultrasound first even if it meant needing a subsequent confirmatory CT, and 193/409 (47.2%) preferred a CT right away. One hundred sixty-nine of 409 (41.3%) patients would still like to have a CT scan of the head after head trauma even if their physician did not believe the test was indicated. CONCLUSION: This study elucidates patient preference and knowledge regarding CT scans. Overall, patients have a poor understanding of CT scan radiation, and desire to have risks explained to them as informed consent prior to the scan.