Impact of a nurse practitioner on patient care in a Canadian emergency department

Abstract

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...

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