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Impact of a nurse practitioner on patient care in a Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Ivan P. Steiner ,
Darren N. Nichols ,
Sandra Blitz ,
Lloyd Tapper ,
Andrew P. Stagg ,
Leneela Sharma  and
Carla Policicchio
Ivan P. Steiner*
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Darren N. Nichols
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Sandra Blitz
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Lloyd Tapper
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Andrew P. Stagg
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Leneela Sharma
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Carla Policicchio
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
*
205 College Plaza, 8215 — 112 St., Edmonton AB T6G 2C8; ivan.steiner@ualberta.ca

Abstract

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Objective:

Our objective was to determine whether the addition of a broad-scope nurse practitioner (NP) would improve emergency department (ED) wait times, ED lengths of stay (LOS) and left-without-treatment (LWOT) rates. We hypothesized that the addition of a broad-scope NP during weekday ED shifts would result in shorter patient wait times, reduced LOS and fewer patients leaving the ED without treatment.

Methods:

This prospective observational study was conducted in a busy urban free-standing community ED. Intervention shifts, with NP coverage, were compared with control shifts (similar shifts with emergency physicians [EPs] working independently). Primary outcomes included patient wait times, ED LOS and LWOT rates. Patient demographics, triage category, the provider seen, the time to provider and ED LOS were captured using an electronic database.

Results:

The addition of an NP was associated with a 12% increase in patient volume per shift and a 7-minute reduction in mean wait times for low-acuity patients. However, overall patient wait times and ED LOS did not differ between intervention and control shifts. During intervention shifts, EPs saw a smaller proportion of low-acuity patients and there was a trend toward a lower proportion of LWOT patients (11.9% v. 13.7%, p = 0.10).

Conclusion:

Adding a broad-scope NP to the ED staff may lower the proportion of patients who leave without treatment, reduce the proportion of low-acuity patients seen by EPs and expedite throughput for a subgroup of less urgent patients. However, it did not reduce overall wait times or ED LOS in this setting.

Keywords

nurse practitioneremergency carequality assuranceemergency departmentemergency physician
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 3 , May 2009 , pp. 207 - 214
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

REFERENCES

1.Worster, A, Sardo, A, Thrasher, C. Understanding the role of nurse practitioners in Canada. Can J Rural Med 2005;10:89–94.Google ScholarPubMed
2.Thrasher, C, Purc-Stephenson, RJ. Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations. CJEM 2007;9:275–81.Google Scholar
3.Drummond, A. Nurse practitioners in Canadian emergency departments: an idea worthy of attention or diverting our attention? CJEM 2007;9:297–9.Google Scholar
4.Steiner, IP, Blitz, S, Nichols, DN, et al. Introducing a nurse practitioner into an urban Canadian emergency department. CJEM 2008;10:355–63.CrossRefGoogle ScholarPubMed
5.Carter, AJE, Chochinov, AH. A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. CJEM 2007;9:286–95.Google Scholar
6.Sakr, M, Kendall, R, Angus, J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Emerg Med J 2003;20:158–63.Google Scholar
7.Kumar, NL, Black, D, McClellan, K. Daytime presentations to a metropolitan ophthalmic emergency department. Clin Experiment Ophthalmol 2005;33:586–92.Google Scholar
8.Beveridge, R. The Canadian Triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physicians. J Emerg Med 1998;16:507–11.Google Scholar
9.Brebner, JA, Ruddick-Bracken, H, Norman, JN, et al. The nurse practitioner: management of minor trauma. Accid Emerg Nurs 1996;4:43–6.Google Scholar
10.Considine, J, Martin, R, Smit, D, et al. Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department. Int J Nurs Pract 2006;12:205–13.CrossRefGoogle Scholar
11.Dolan, B, Dale, J, Morely, V. Nurse practitioners: the role in A&E and primary care. Nurs Stand 1997;11:33–8.CrossRefGoogle Scholar
12.Derlet, RW, Richards, J. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000;35:63–8.CrossRefGoogle ScholarPubMed
13.Trzeciak, S, Rivers, EP. Emergency department overcrowding in the United States: an emerging treat to patient safety and public health. Emerg Med J 2003;20:402–5.CrossRefGoogle Scholar
14.Rowe, BH, Bond, S, Ospina, MB, et al. Frequency, determinants, and impact of overcrowding in emergency departments in Canada: a national survey of emergency department directors Technology report no. 67.3]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2006.Google Scholar
15.Asplin, BR, Magid, DJ, Rhodes, KV, et al. A conceptual model of emergency department crowding. Ann Emerg Med 2003;42:173–80.CrossRefGoogle ScholarPubMed
16.Holroyd, BR, Bullard, MJ, Latoszek, K, et al. Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial. Acad Emerg Med 2007;14:702–8.Google Scholar
17.Health Quality Council of Alberta. Emergency Department Patient Experience Survey. The Council; 2008. Available: www.hqca.ca/assets/pdf/News%20Releases/HQCA_ED_Survey/HQCA_ED_survey_technical_report.pdf (accessed 2009 Apr 2).Google Scholar
18.Fernandes, CM, Price, A, Christenson, JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997;15:397–9.Google Scholar
19.Rowe, BH, Channan, P, Bullard, M, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med 2006;13:848–52.Google Scholar
20.Jack, LKA, Thomson, J, Nemeth, L. Does the emergency department of a Canadian tertiary-care university-affiliated hospital meet the time goals set by the Canadian Triage and Acuity Scale? ISRJEM 2008;89:8–14. Available: http://isrjem.org/March08_NEMETH-DOES%20A%20CANADIAN.postprod.pdf (accessed 2009 Mar 27).Google Scholar
21.Rogers, T, Ross, N, Spooner, D. Evaluation of a see and treat pilot study introduced to an emergency department. Accid Emerg Nuis 2004;12:24–7.CrossRefGoogle Scholar
22.Considine, J, Martin, R, Smit, D, et al. Emergency nurse practitioner care and emergency department patient flow: case-control study. Emerg Med Australas 2006;18:385–90.Google Scholar
23.Jennings, N, O’Reilly, G, Lee, G, et al. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia. J Clin Nurs 2008;17:1044–50.Google Scholar