The purpose of this research is to examine the effect of having nursing case managers (NCMs) assigned in the emergency department (ED). This research evaluates criteria from the following aspects: inappropriate admissions to the intensive care unit precertification of admissions to the hospital, intensive case unit diversion rates for the hospital, cost savings, and staff and patient satisfaction. The method utilized was a pretest and posttest design examining data on several variables before and after placing the NCMs in the ED. The time frame for the study is 1 year in an urban, 534-bed acute care teaching facility. NCMs were assigned to the ED 7 days a week and were responsible for precertification for admissions and working with physicians to determine that patients are admitted to the most appropriate level of care. Data will be collected through a variety of sources.