Introduction: US emergency personnel cared for 106% more patients in 1990 than they did in 1980, 1 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). Methods: 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. Results: 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. Conclusion:The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources. RÉSUMÉIntroduction : Aux États-Unis, le personnel des services d'urgence a traité 106 % plus de patients en 1990 qu'en 1980, 1 et les données de recensement à l'échelle nationale sur les services d'urgence révèlent qu'entre 60 % et 80 % de ces patients présentaient des problèmes médicaux non urgents ou mineurs. Le recours à des infirmières praticiennes (IP) est une solution que l'on propose pour alléger la surcharge de travail et la pénurie de médecins dans les urgences. Méthodes : Nous avons fait une recension systématique des articles dans MEDLINE et Cinahl portant sur les IP dans les urgences, en s'attachant plus précisément à quatre mesures de résultats clés : les temps d'attente, la satisfaction des patients, la qualité des soins et la rentabilité des coûts. Résultats : Même si certaines questions restent en suspens, une recension des écrits nous indique

No abstract

This is an accepted version of a paper published in Prehospital Emergency Care. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Lundgren, P., Henriksson, O., Pretorius, T., Cahill, F., Bristow, G. et al. (2009) Supplemental meperidine (maximum cumulative dose of 3.5 mg/kg) was administered as required to inhibit shivering.

Purpose -The purpose of this paper is to introduce a method of the bottleneck detection for Emergency Department (ED) improvement using benchmarking and design of experiments (DOE) in simulation model. Design/methodology/approach -Four procedures of treatments are used to represent ED activities of the patient flow. Simulation modeling is applied as a cost-effective tool to analyze the ED operation. Benchmarking provides the achievable goal for the improvement. DOE speeds up the process of bottleneck search. Findings -It is identified that the long waiting time is accumulated by previous arrival patients waiting for treatment in the ED. Comparing the processing time of each treatment procedure with the benchmark reveals that increasing the treatment time mainly happens in treatment in progress and emergency room holding (ERH) procedures. It also indicates that the to be admitted time caused by the transfer delay is a common case.Research limitations/implications -The current research is conducted in the ED only. Activities in the ERH require a close cooperation of several medical teams to complete patients' condition evaluations. The current model may be extended to the related medical units to improve the model detail. Practical implications -ED overcrowding is an increasingly significant public healthcare problem. Bottlenecks that affect ED overcrowding have to be detected to improve the patient flow. Originality/value -Integration of benchmarking and DOE in simulation modeling proposed in this research shows the promise in time-saving for bottleneck detection of ED operations.