‘Nurse specialling’: Direct nursing observation in the emergency department compared to other wards of an urban teaching hospital in Sydney

This study examined the patterns of direct observation of patients by nursing staff (‘nurse specials’) and compared those required for mental health/drug health (MH/DH)-related presentations to other patient groups in different care settings. A retrospective review of nurse special shifts requested during the 2014 calendar year at an urban teaching hospital. Hospital-wide 14,021 8-hour nursing shifts were ordered for special observation of patients, an average of 39 per day. Of these, 30% were requested for MH/DH-related presentations, with the majority (70%) required for medically unstable patients. However, of the 1917 shifts required in the emergency department, 1841 (96%) were for MH/DH presentations compared to 76 (4%) for patients with unrelated medical conditions (odds ratio 98.2; 95% confidence interval 77.71–124.06, P<0.0001). In contrast to the rest of the hospital, emergency department-based nurse special requests were significantly more likely to be for MH/DH presentations. This figure represents a considerable staff and financial burden and may be reduced by diversion or more rapid transfer of such presentations to an appropriate inpatient ward