Hospital and emergency department length of stay before and after virtual nursing implementation
In brief
Virtual nursing linked to 0.8-day shorter hospital stays across nine hospitals
In a retrospective study of 129,080 emergency admissions, centralized virtual nursing was associated with hospital stays about 0.8 days shorter and emergency department stays about 0.4 hours shorter. Improvements emerged six to seven months after rollout, and results varied by patient acuity and region, so benefits may depend on how workflows mature and fit local hospitals.
- Journal
- International journal of medical informatics (Q1)
- Published
- 2 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Saif Khairat, Zhaoqiang Zhou, Jennifer Morelli, Cheryl B Jones
- PMID
- 42976388
- DOI
- 10.1016/j.ijmedinf.2026.106791
Why clinicians should know about it
- Picked for Health Informatics (paper of the day, 8 November 2026): Multi-hospital evaluation links virtual nursing implementation with length of stay
Abstract
OBJECTIVES: To determine whether hospital-level implementation of a centralized virtual nursing (VN) program was associated with changes in hospital length of stay (HLOS) and emergency department length of stay (EDLOS), and when these changes emerged. METHODS: We conducted a retrospective cohort study of adults admitted through the emergency department at nine hospitals in a Southeastern U.S. health system. Hospital-specific electronic health record data from 12-month preimplementation and postimplementation periods were analyzed. The primary analysis used a staggered difference-in-differences design with not-yet-treated hospitals as comparators. Propensity score-matched comparisons and subgroup analyses provided complementary evidence. RESULTS: The cohort included 129,080 encounters. Propensity score matching yielded 61,908 encounters in each of the preimplementation and postimplementation groups. In the primary analysis, VN implementation was associated with reductions in HLOS (aggregated average treatment effect on the treated [ATT], -0.786 days; 95 % CI, -0.940 to -0.631) and EDLOS (ATT, -0.398 h; 95 % CI, -0.516 to -0.281). Event-study estimates became consistently negative six months after implementation for HLOS and seven months after implementation for EDLOS. Mean HLOS decreased from 6.5 to 5.5 days, while median HLOS remained 3.9 days (P < 0.001). Mean EDLOS decreased from 5.9 to 4.9 h, and median EDLOS decreased from 3.6 to 2.7 h (P < 0.001). Patterns varied by patient acuity and hospital region. CONCLUSION: Centralized VN implementation was associated with gradual improvements in hospital-level outcomes across nine hospitals. The delayed and context-dependent changes suggest that operational benefits may emerge as virtual admission workflows mature and become integrated into routine care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.