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. RÉSUMÉObjectif : Nous avons cherché à déterminer si l'ajout d'une infirmière praticienne généraliste améliorerait les temps d'attente, la durée de séjour et le nombre de patients qui quittent l'urgence sans avoir été vus. Nous avons formulé une hypothèse selon laquelle l'ajout d'une infirmière praticienne généraliste à l'urgence durant les quarts de travail du lundi au vendredi abrégerait les temps d'attente et la durée de séjour à l'urgence et réduirait le nombre de patients qui quittent l'urgence sans avoir été vus. Méthodes : Nous avons réalisé cette étude d'observation prospective en milieu urbain dans un service d'urgence indépendant et achalandé. Nous avons comparé les quarts de travail au cours desquels une infirmière praticienne était sur place à des quarts « témoins » (quarts similaires, au cours desquels les médecins d'urgence travaillaient sans la collaboration de l'infirmière praticienne). Les principales mesures de résultats incluaient les temps d'attente, la durée de séjour et le nombre de patients quittant l'urgence sans avoir été vus. Une base de données électronique a permis de recueillir les renseignements démographiques suivants : catégorie de triage, professionnel de la santé consulté, temps d'attente et durée du séjour à l'urgence. Résultats : L'ajout d'une infirmière praticienne a été associé à une augmentation de 12 % du volume de patients par quart et à une réduction de 7 minutes du temps d'attente moyen ch...

Key Points Question Is competency-based assessment associated with changes in rates of identification of and support for residents in difficulty compared with traditional assessment? Findings In this cohort study of 458 Canadian medical residents, there were significant reductions in the proportions of residents receiving flagged assessments on multiple rotations, reductions in proportions of residents defined as being in difficulty, and increases in documented evidence identifying that gaps were discussed with the resident following introduction of a competency-based assessment program. Meaning Competency-based assessment may contribute to better identification of and support for residents in difficulty.

A simulation-based model of Disaster Medicine training, requiring approximately eight hours of classroom time, was judged by Emergency Medicine residents to be a valuable component of their medical training, and increased their confidence in personal and departmental disaster management capabilities.

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Objective:Our objective was to compare the emergency care provided by a nurse practitioner (NP) with that provided by emergency physicians (EPs), to identify emergency department (ED) patients appropriate for autonomous NP practice and to acquire data to facilitate the development of the clinical scope of practice recommendations for ED practice for NPs. Methods: Using a comprehensive 3-part process, we selected and hired the best NP from 12 applicants. The NP was oriented to the operations of our free-standing community ED and incorporated in the care team, working in real time with EP preceptors during a 6-month, prospective clinical assessment comparing NP care with EP care. ED preceptors reviewed every case in real time with the NP and completed an explicit evaluation form to determine whether NP assessment, investigation, treatment and disposition were "all equivalent to emergency physician care" (AEEPC) or whether they differed. The proportion of AEEPC interactions was determined for 23 patient presentation categories. Our a priori assumption was that a patient presentation category might be suitable for autonomous NP practice if 50% of NP encounters in that category were rated as AEEPC. Descriptive data were presented for patient case mix, teaching domains and time criteria. Results: Eighty-three NP shifts and 711 patient encounters were evaluated by 21 EP preceptors. The NP saw a median of 8 patients per shift. In 43% of encounters, NP care was AEEPC. Highest AEEPC rates were found in the patient follow-up categories general follow-up (55.4%), diagnostic imaging (91.7%) and microbiology laboratory results (87.6%). NP scores over 50% were also seen for lacerations (63.6%) and isolated sore throats (53%). With teaching, NP performance improved over time. Conclusion: With the exception of follow up-related complaints, simple lacerations and isolated sore throats, NP care differed substantially from EP care. Although NPs with extensive emergency experience and training might ultimately be able to function as autonomous ED care providers, Canadian EDs currently developing job descriptions for emergency NPs should focus on a model of collaborative practice with EPs. ORIGINAL RESEARCH • RECHERCHE ORIGINALE