Estimation of the nurse-to-patient optimal ratio in the emergency department based on workload: OPTIRATIO Study

Objective.

To establish the optimal nurse-patient ratio based on the area of care, the level of triage and the level of dependence of the patients.

Method.

Observational study to assess the nursing load of an emergency department between October 2024 and January 2025 using the Assessment of Nursing Workloads and Time (VACTE)© scale. The covariates of complexity (high/low), triage level, dependence (Barthel), sex and age were recorded. The ratio was established using a multivariate model and information on the actual influx and the number of existing nurses.

Results.

A total of 409 patients were analysed. Time per patient was statistically higher as age increased and according to the level of dependence. It was also superior in the area of high complexity and resuscitation, as well as in patients classified as triage level 1. 46% of the variability in the time spent with patients was explained by the level of triage and age, the number of nurses needed according to the data was 14,77. 12,09 nurses in the high complexity area and 2,2 in the low complexity area for a real workload of 223,4 patients/24h.

Conclusions.

The workload was directly proportional to age, the complexity of the triage level and the degree of dependency. Based on the data, it is possible to propose an optimal nurse-patient ratio.