Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study

Abstract

Aims The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. Background Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. Design Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Methods Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. Results The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300 min (772.25 ± 831.91 vs. 471.44 ± 336.65, p = <.001). Similarly, time to place emergency department discharge order was shorter by 49 min (277.76 ± 159.69 vs. 228.27 ± 116.04, p = .001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06 ± 0.23 vs. 1.46 ± 0.74, p < .001). Conclusion The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. Relevance to Clinical Practice Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes

“…Beyond routine institutional reviews of ENP practice, the literature demonstrates collective evidence of quality and safe care provided by ENPs. Similar to the successes experienced by the inclusion of NPs among inpatient hospital services (Aiken et al, 2021; Hardway et al, 2022), the benefits of NPs within emergency care teams have been repeatedly demonstrated in the literature for decades (Carter & Chochinov, 2007; Fowler et al, 2019; Powers et al, 1984). Multiple US studies have reported positive outcomes of emergency care delivered by NPs.…”