Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes

Fowler, Leanne H.; Landry, Jessica; Nunn, Melissa F.

doi:10.1016/j.cnc.2019.02.010

Cited by 14 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Implementation of the 24/7 TNP model at the study institution shortened the stay in the ED by an average of 5 h. The study also reported prompt placement of ED discharge order by the TNPs. These findings are consistent with studies conducted by Fowler et al (2019); Li et al (2013). Li et al (2013) noted that nurse practitioners play an important role in relieving ED waiting room volumes for patients presenting with minor complaints or injuries.…”

Section: Discussionsupporting

confidence: 93%

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

Hardway

Lucente

Crawford

et al. 2022

Journal of Clinical Nursing

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 93%

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

Hardway

Lucente

Crawford

et al. 2022

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…Similarly, in another systematic review, Rowe et al 51 had reported a positive impact of triage liaison physicians on ED patient flow metrics. A more recent review reported that NPs practicing in the ED improved ED quality metrics and patient satisfaction, 52 while another review investigating strategies to alleviate access block and overcrowding, suggested that co-locating primary care, fast-track and NPs within ED may have a positive impact. 53 Other reviews, however, have reported a limited impact of ‘within-ED’ interventions on ED patient flow metrics.…”

Section: Discussionmentioning

confidence: 99%

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

et al. 2021

View full text Add to dashboard Cite

ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

show abstract

“…Nurse practitioners (NPs) may be one of the solutions to the rising demand for emergency care. Multiple international studies have suggested that the implementation of NPs into EDs improves patient outcomes overall compared to other providers (Carter & Chochinov, 2007;Fowler et al, 2019). NPs are registered nurses with additional education at the master's or doctoral level, who integrate their knowledge of advanced practice, health promotion, disease prevention, and other related theories to provide comprehensive health services (Almost, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Assessing systems and patient-level healthcare outcomes, like those described above, is a vital aspect of identifying challenges and improving patient care (Fowler et al, 2019;Kleinpell, 2013). Kleinpell (2013) states that assessing the outcomes after implementing NPs and their contribution is vital for their utilization.…”

Section: Introductionmentioning

confidence: 99%

A Scoping Review of the Impact of Emergency Department Nurse Practitioners on Healthcare Outcomes in Canada Patient Safety Solution

Bazavluk¹,

Pant²,

Vyas³

et al. 2022

IJCC

View full text Add to dashboard Cite

Background: Nurse Practitioners (NPs) are a valuable yet untapped resource in Canadian healthcare – especially in the emergency department (ED). Multiple international studies showed positive outcomes associated with NPs working in EDs, but limited Canadian studies are available. Aim: The objective of this study was to review the literature available in Canada on the outcomes associated with having NPs in the ED. These outcomes include wait times, length of stay (LOS), rates of patients who left without being seen (LWBS), willingness to be treated by an NP, and patient satisfaction with their treatment by an NP. Methods: This scoping review was informed by the procedures outlined by the Joanna Briggs Institute. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Two independent reviewers systematically searched CINAHL, EMBASE, SCOPUS, Cochrane Library, and MEDLINE in January 2022. All peer-reviewed articles that met the eligibility criteria were included. A pair of independent reviewers completed the selection process, screening, and data extraction. The reviewers discussed disagreements until they reached a consensus. Results: A total of five studies met the inclusion criteria. Decrease in wait times, LOS, rates of patients who LWBS, and increase in patient throughput were noted. One study did not find significant improvement in wait times, LOS, and rates of patients who LWBS. There was also a high rate of patient satisfaction and willingness to see an NP. Conclusion: This review shows evidence of positive change on the outcomes of decreased wait times, LOS, rates of patients who LWBS, and patient satisfaction associated with having NPs in EDs. However, there is limited up-to-date evidence in the Canadian literature leaving room for future research. Future research needs to address outcomes associated with NPs working in the ED in Canadian provinces other than British Columbia, Alberta, and Ontario, research that is more in line with the current political climate of the pandemic and lack of resources, and how NPs can be best integrated into EDs

show abstract

Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes

Cited by 14 publications

References 13 publications

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

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

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

A Scoping Review of the Impact of Emergency Department Nurse Practitioners on Healthcare Outcomes in Canada Patient Safety Solution

Contact Info

Product

Resources

About