THE IMPACT OF EMERGENCY NURSE PRACTITIONER TO THE QUALITY OF CARE (original) (raw)
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CJEM, 2007
US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%-80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs). We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness. Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking. The medical community should further expl...
Emergency nurse practitioner practice analysis: Report and implications of the findings
Journal of the American Association of Nurse Practitioners, 2018
Background and purpose: A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination. Method: In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs). Evidence from the validation survey was used to create a test content outline for the ENP examination. Findings and Conclusions: The delineation of ENP practice validated by the survey (Cronbach alpha = 0.86–0.94 across rating scales) included 5 ENP practice domains: medical screening, medical decision-making/differential diagnoses, patient management, patient disposition and professional, legal and ethical practices. There were 22 job tasks across domains, 10 types of patient cond...
Evaluating emergency nurse practitioner services: a randomised controlled trial
Journal of Advanced Nursing, 2002
Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial.Methods. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care ( n = 99) or Senior House Officer (SHO)-led care ( n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a ‘Documentation Audit Tool’. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.Results. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to ( P = 0·009); gave them information on accident and illness prevention ( P = 0·001); and gave them enough information on their injury ( P = 0·007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs ( P < 0·001). ENPs' clinical documentation was of higher quality than SHOs ( P < 0·001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow-up between groups. Missed injuries were the same for both groups ( n = 1 in each group).Conclusion. The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP-led than SHO-led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.
Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes
Critical Care Nursing Clinics of North America, 2019
In busy emergency departments (ED), efficacy and performance are measured through certain health care metrics. In the ED, common metrics include a patient's length of stay (LOS) and time to treatment. Patient LOS is the time between checkin to discharge or admission. Time to treatment is the time between checking in to the ED until assessment by a medical provider (eg, nurse practitioner [NP], physician's assistant, or physician). Other outcomes measured in the ED include patient satisfaction and financial outcomes, such as cost and expenditures. Through clinical processes, such as "door-to-balloon" protocols for acute coronary events, many patient outcomes are measured in the ED. LOS metrics can assist ED
Update Dental College Journal, 2016
Emergency department is one of the most important part of the hospital and also vulnerable to criticism. The reputation of a hospital rests to a large extent on the service of emergency department. A descriptive type of cross sectional study was conducted at Emergency Department (ED) of National Institute of Cardiovascular Diseases Hospital (NICVD), Dhaka to assess different aspects of the service management of ED which includes opinion regarding different services, reception facilities, overall management of ED, waiting time for the patients to be attended by a doctor, required time for completion of emergency treatment, suggestions of service receivers for further improvement of ED of the hospital. A total of 121 patients or patient attendance and 39 health personnel were interviewed by a structured questionnaire and a checklist was utilized for availability of equipments and drugs in ED. The collected data were processed and analyzed meticulously with the help of SPSS (Version 2...
Emergency Medicine Australasia, 2015
Study Objective: To identify current ED models of care and their impact on care quality, care effectiveness, and cost. Methods: A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on Emergency Department (ED) models of care. Additionally, a focussed review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. Articles published between 1998 and 2013 in the English language were included for initial review by three of the authors. Studies in underdeveloped countries and not addressing the objectives of this study were excluded. Relevant details were extracted from the retrieved literature, and analysed for relevance and impact. The literature was synthesised around the study's main themes. Results: Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost effective analysis of service models. Conclusion: Whilst various models of delivering emergency health care exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost effectiveness.
Emergency NP Model of Care in an Australian Emergency Department
The Journal for Nurse Practitioners, 2015
This study aimed to evaluate the effectiveness of nurse practitioner service on key emergency department indicators. A pragmatic randomized controlled trial was conducted. Patients were randomly assigned to standard emergency department care or nurse practitioner care. The outcome measures reported were comparisons on key service indicators. There were 260 patients enrolled in the study, 128 receiving standard emergency department medical care and 130 receiving nurse practitioner care. There were no significant differences between the 2 groups regarding waiting times, length of stay, numbers of patients who left, patient representations within 48 hours, and the use of evidence-based guidelines.
The efficacy and value of emergency medicine: a supportive literature review
International Journal of …, 2011
Study objectivesThe goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established.MethodsThe January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included.ResultsA total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles).ConclusionThere is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.