Abstract
Background
A regional hospital emergency department was facing increasing patient presentations,
medical workforce shortages and long delays for patients to be seen. Furthermore,
a high percentage of low acuity ambulatory patients were not waiting to be seen.
Aim
To introduce a sustainable / long-term nurse practitioner (NP) led model of care to
address the identified emergency department service requirements for low acuity ambulatory
patients.
Methods
A descriptive exploratory design was used to establish and monitor a NP model. Organisational
support and a steering committee was used to monitor clinical safety and patient satisfaction.
Data was collected in relation to number of patients seen, conditions managed by nurse
practitioners, time to treatment, length of stay and compliments and complaints received.
Findings
NPs within this service now comprise 10% of the treating clinician workforce, see
15% of total presentations, contribute to a reduction in waiting time, length of stay
within the targeted cohort and meeting National Emergency Access Targets 95% of the
time.
Discussion
Establishment of a NP model has been successful at addressing the needs of low acuity
patients in the emergency department as evidenced by reduced waiting times, length
of stay and customer satisfaction. We attribute this success to the following three
key factors: targeting a patient population, commitment to the service and adaptability.
Conclusion
Development of a dedicated NP model has enabled the emergency department to safely
and sustainably provide care to low acuity ambulatory patients.
Keywords
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References
ACEM. (2000). https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Better-Outcomes-for-Patients/Triage.aspx.
- 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 (Retrieved from): 286-295
- Expert panel review of elective surgery and emergency access targets under the national partnership agreement on improving public hospital services.2011
- Lessons learned in developing and implementing the nurse practitioner role in an urban Canadian emergency department.Journal of Emergency Nursing: JEN : Official Publication of the Emergency Department Nurses Association. 2012; 38: 484-487https://doi.org/10.1016/j.jen.2011.08.015
- Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors.Australasian Emergency Nursing Journal : AENJ. 2012; 15: 188-194https://doi.org/10.1016/j.aenj.2012.09.001
Emergency Department Information System. (2018).
- The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review.International Journal of Nursing Studies. 2015; 52: 421-435https://doi.org/10.1016/j.ijnurstu.2014.07.006
- Evaluating patient presentations for care delivered by emergency nurse practitioners: A retrospective analysis of 12 months.Australasian Emergency Nursing Journal : AENJ. 2013; 16: 89-95https://doi.org/10.1016/j.aenj.2013.05.005
- Highlighting the invisible work of emergency nurse practitioners.The Journal for Nurse Practitioners. 2018; 14 (e21): 26-32https://doi.org/10.1016/j.nurpra.2017.09.023
- Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: Systematic review.BMJ Open. 2015; 5e007167https://doi.org/10.1136/bmjopen-2014-007167
- Demonstration nurse practitioner role emergency department: 2005-12 month report.2006
- Nursing and Midwifery Board of Australia Registrant data: Reporting period: 1 October 2017–31 December 2017.(Retrieved from)2018
- Development of clinical competencies for emergency nurse practitioners: A pilot study.Australasian Emergency Nursing Journal. 2012; 15: 195-201https://doi.org/10.1016/j.aenj.2012.10.004
- Qualitative research & evaluation methods.2002
- Evaluating an australian emergency nurse practitioner candidate training program.Australasian Emergency Nursing Journal : AENJ. 2017; 20: 161-168https://doi.org/10.1016/j.aenj.2017.07.001
- The pediatric nurse practitioner at Colorado.The American Journal of Nursing. 1967; 67: 1443-1444https://doi.org/10.2307/3420623
- Nurse Practitioners: A contract for change and excellence in nursing.Collegian. 2002; 9: 18-23https://doi.org/10.1016/S1322-7696(08)60429-1
- Emergency nurse practitioners: An underestimated addition to the emergency care team.Emergency Medicine Australasia : EMA. 2008; 20: 453-455https://doi.org/10.1111/j.1742-6723.2008.01128.x
Article info
Publication history
Published online: December 19, 2018
Accepted:
November 30,
2018
Received in revised form:
November 20,
2018
Received:
August 10,
2018
Identification
Copyright
© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
