Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain: protocol for a multicentre, longitudinal nested cohort study

Abstract

IntroductionChest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and supported clinicians in the delivery of safe and effective care, including the use of emergency nurse practitioners (ENPs). Despite increasing use of ENPs, little is known about the safety and quality of the service in the rural ED context. The aims of this study are (1) to examine the safety and quality of the ENP service model in the provision of care in the rural environment and (2) to evaluate the effectiveness of the service in the management of patients presenting with undifferentiated chest pain.Methods and analysisThis is the protocol for a prospective longitudinal nested cohort study to compare the effectiveness of ENP service with that of standard care. Adults presenting to three rural EDs in Queensland, Australia with a primary presenting complaint of atraumatic chest pain will be eligible for enrolment. We will measure (1) clinician's use of evidence-based guidelines (2) diagnostic accuracy of ECG interpretation for the management of patients with suspected or confirmed ACS (3) service indicators of waiting times, length-of-stay and did-not-wait rates and (4) clinician's diagnostic accuracy as measured by rates of unplanned representation within 7 days (5) satisfaction with care, (6) quality-of-life and (7) functional status. To assess these outcomes we will use a combination of measures collected from routinely collected data, medical record review and questionnaires (with 30-day follow-up).Ethics and disseminationQueensland Health Human Research Ethics Committee (HREC) has approved this protocol. The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.

The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study

“…Sample size calculations were based on the primary outcome for the study and reported in the previously published study protocol [ 36 ]. Using the results from our preliminary study [ 37 ], we anticipated a six-month period for data collection; however, there were critical issues with participant recruitment necessitating termination of the study prior to achieving the requisite sample.…”

“…Using the results from our preliminary study [ 37 ], we anticipated a six-month period for data collection; however, there were critical issues with participant recruitment necessitating termination of the study prior to achieving the requisite sample. Data analysis was performed according to the pre-published analysis plan [ 36 ].…”

Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care

“…Nurse practitioners have a direct role in improvement of risk stratification and timely reperfusion. 25,26 Better risk assessment increases inclusion in secondary prevention and rehabilitation programmes targeting lifestyle changes and pharmaceutical therapy. Furthermore, an updated and shared STEMI protocol, use of checklists, and oral and written discharge instructions could improve documentation and prescription of discharge medication.…”

Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions

“…This includes the capability to assess, diagnose and treat; initiate referrals to other health care workers; request and interpret diagnostic tests; prescribe and review medications and discharge [ 12 – 14 ]. These skills and competencies are important in the delivery of safe and effective health care in a rural UCC, such as timely assessment and initiation of chest pain management [ 15 ] and the clinical capability to see and treat all presentations from mild through to high acuity [ 11 ]. Despite being introduced in Australia in 2000, the NP-led model of care has yet to realise its full potential as a legitimate option for addressing workforce needs in rural health care delivery [ 16 – 18 ].…”