This study examined organizational factors within U.S. hospital emergency rooms (ERs) that impact care teams’ adherence to established, time-sensitive sepsis protocols. Analysis revealed that for each 1% increase in annual patient walk-out rates, compliance with sepsis protocols declines by 2.10%. Additionally, the impact on poor ER throughput where the Emergency Severity Index (ESI) level 3 length of stay increases by 1 minute, a hospital's compliance with implementing the present on admission (POA) sepsis bundle within 3 hours decreases by .08%. These findings underscore the need to optimize ER processes aimed at throughput and operational performance. The research also found that low engagement levels among ER RNs were linked to higher RN turnover rates. High RN engagement was associated with improved collaboration with physicians. This suggests disengaged staff contribute to rising walk-out rates, negatively affecting compliance with the three-hour present on admission (POA) sepsis bundle. Elevated RN engagement correlates with better ER throughput, as indicated by shorter lengths of stay for patients classified as Emergency Severity Index (ESI) Level 3. Finding highlights the crucial role of employee engagement in staff retention and the hospital’s effective implementation of medical protocols. Implications for hospital management are discussed.
