As a former emergency department Registered Nurse for over seven years, I recall the most significant complaints were our long wait times.  For some patients, the wait time could be substantial.  Since emergency departments aren’t on a first-come, first-serve basis, wait times were often unpredictable and lengthy.  Patients are triaged based on their level of acuity.  Long Emergency Department (ED) Length of stay (EDLOS) is associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. (Andersson et al., 2020, p. 2)

The method conducted for the concept analysis on EDLOS was the Walker and Avant approach.  They were able to research a way of measuring the concept empirically by identifying all concepts used.  (Andersson et al., 2020) Nurses can use the Walker and Avant approach when there are limited concepts available to a nurse to explain a problem area.  The process of concept analysis for nurses first transpired in 1986. (McEwen & Wills, 2019) Walker and Avant specifically designed an approach to concept analysis to help graduate nurses explain methods to examine phenomena that interests them.  (McEwen & Wills, 2019) The basic concept analysis approach by Walker and Avant is as follows; 1.  Select a concept  2. Determine the aims or purposes of the analysis.  3.  Identify all the concept possible uses possible.  4.  Determine the defining attributes.  5.  Identify the model case.  6.  Identify any borderline, related contrary, invent, and illegitimate cases.  7.  Identify the antecedents and consequences.  8.  Define the empirical referents. (McEwen & Wills, 2019, Tables 3-2)

Authors Aim and Purpose

As a former Emergency Department Nurse, I find it fascinating how the author chose to do the concept analysis on this topic.  According to the author, when patients are forced to stay for extended lengths of time in the emergency department, this leads to poor patient outcomes, overcrowding, and an overall inefficient organization. (Andersson et al., 2020) I recall when a febrile child was left in the Emergency Department for a long time.  The child became so agitated their respiratory status worsened.  The authors aim to clarify the meaning of long EDLOS and identify the root causes of an emergency department length of stay of more than six hours.  (Andersson et al., 2020)

Defining Attributes on the Concept Examined

In the emergency department, length of stay (LOS) is a widely used measurement.  Emergency department length of stay (EDLOS) is defined as the time interval between a patient’s arrival to the ED to the time the patient physically leaves the ED. The defining attributes discovered that waiting in a crowded emergency department was just that, waiting.  Waiting was the most acknowledged attribute associated with EDLOS. (Andersson et al., 2020) If the patients didn’t have to wait, they wouldn’t be a problem/complaint and had no time targets. 

Another attribute that was described as a cause for EDLOS was, crowding.  This led to cause and effect with long EDLOS and crowding. (Andersson et al., 2020)

Benefits

     The problem was that over-crowding and waiting was referred to as an inefficient organization.  This led to the need to search for EDLOS to correct the issues with the system and improve overall patient satisfaction with emergency department visits.  (Andersson et al., 2020)  The benefit of this study is discovering what the root of the cause is for long emergency wait times, therefore improving overall patient outcomes, avoiding overcrowding, and running an efficient organization.  The benefits of completing a concept analysis for nursing theory would be to aim at improvements for better patient outcomes.  This is what we are there for, after all.  As nurses, we are on the front lines of our departments, and we have an opportunity to improve our systems, our organizations, our team, but most importantly, our patients.  When we can all benefit as a team, our profession benefits, and our patients benefit greatly.