Nurse practitioners in the emergency department: Establishing a successful service

Plath, Sharyn J.; Bratby, Jean A.; Poole, Lee; Forristal, Catherine E.; Morel, Douglas

doi:10.1016/j.colegn.2018.11.005

Cited by 11 publications

(11 citation statements)

References 11 publications

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“…Each ED setting should have an identified paediatric emergency care coordinator (PECC) that can be either a physician or nurse who promotes adequate infant and child emergency care and resuscitation skills for the rest of the healthcare providers and staff such as physician assistants (PAs), and advanced practice nurses (APRNs). These PECCs should be active coordinators and facilitators of quality improvement initiatives, education, and community resources related to the care of paediatric patients 69 . The use of APRNs is a viable option to reduce the burden of increased patient load in EDs and has led to reduced wait times and lengths of stay, while increasing customer satisfaction 69,70 …”

Section: Discussionmentioning

confidence: 99%

“…These PECCs should be active coordinators and facilitators of quality improvement initiatives, education, and community resources related to the care of paediatric patients 69 . The use of APRNs is a viable option to reduce the burden of increased patient load in EDs and has led to reduced wait times and lengths of stay, while increasing customer satisfaction 69,70 …”

Section: Discussionmentioning

confidence: 99%

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Frequent emergency department use in the paediatric population: A systematic literature review

Giannouchos

Washburn

Gary

2020

Evaluation Clinical Practice

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Objective We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. Methods We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. Results Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. Conclusions Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost‐saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequent emergency department use in the paediatric population: A systematic literature review

Giannouchos

Washburn

Gary

2020

Evaluation Clinical Practice

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“…The innovative, and embedded Nurse Practitioner health non‐randomized intervention will address the deficits in current health care through an in‐depth assessments of children's health needs, facilitation of treatment plans, referrals to appropriate health services, support to aide referral compliance and provide parental education on developmental health checks. This is evidenced by previous studies that have demonstrated the effectiveness of Nurse Practitioner‐led models of care in addressing missed care for disadvantaged/vulnerable populations (Adams & Schofield, 2009; Agosta, 2009; Creech et al, 2011; Jennings et al, 2015; Johnson, 2017; Lau et al, 2016; Lowe, 2014; Martin‐Misener et al, 2015; Parry & Abbott, 2017; Platha et al, 2018; Queensland Government Health, 2018; Woo et al, 2017). To our knowledge, no study to date has explored the benefits of a Nurse Practitioner‐led health intervention for children living in hosing instability.…”

Section: The Studymentioning

confidence: 85%

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non‐randomised, concurrent mixed methods study protocol

Parry

Willis

Kendall

et al. 2022

Journal of Advanced Nursing

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In 2019–2020 we conducted a pilot study of a Nurse Practitioner clinic working with housing insecure children (0–18 years) that found high levels of developmental delay, missed immunizations and dental caries. This present non‐randomized, concurrent mixed‐methods study protocol explains the next phase of the research designed proving proof of concept for a Nurse Practitioner model of care for these vulnerable children. Focusing on identifying and understanding clinic admission processes, tracking referral pathways and uptake, and how many vulnerable children miss potential care and why. This will help us to understand and address gaps in health service delivery for this cohort. Design The study uses a concurrent mixed‐ method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). Methods The concurrent mixed‐method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. Discussion Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in‐depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. Impact Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18 years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long‐term health outcomes.

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“…Mostly, the methods developed are used to control costs and the number of patients treated by reducing the waiting time and the LOS of patients in ED (Salway et al, 2017;Plath et al, 2018). Simply, the LOS is equal to the sum of the waiting time and the treatment time of a patient.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Experimental Simulation Design for the Emergency Departments

Atalan¹,

Dönmez

2020

BJO&PM

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Goal: this research aims to use the experimental simulation method is to obtain the optimum results by using the simulation technique of the models which are modeled mathematically but not solved. Design/Methodology/Approach: a case study was conducted to apply discrete-event simulation (DES) approach based on design of experiment (DOE) technique to derive strategies and analyze situations in an emergency department (ED). Results: by integrating the DOE approach with the DES technique for the ED, the average waiting time of a patient in a small ED was reduced from 40.09 minutes to 9.83 minutes (75.48%), resulting in a significant result. The number of patients treated was increased from 132 to 147 (11.37%) by increasing the capacity of resources without increasing the number of resources for ED in daily. Additionally, optimum the numbers of resources of the healthcare were calculated to employ in EDs. Limitations of the investigation: there is no shift system for the resources of healthcare in the DES model. Since the ED was considered in this study, the same number of resources were run during the working hours of the DES model. Practical implications: for researches and healthcare professionals, the developed method is used to provide the possibility of obtaining the results which cannot be obtained by mathematical modeling of the healthcare problems. The results of the changes made in health resources on the outputs are obtained by this method as the shortest and lowest cost. Originality/Value: there is almost no detailed study of DES with DOE. Providing high reliability has resulted for the optimum values by integrating the DOE approach with the DES technique in healthcare area. It is very difficult to get accurate results everywhere where the human factor is.

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Nurse practitioners in the emergency department: Establishing a successful service

Cited by 11 publications

References 11 publications

Frequent emergency department use in the paediatric population: A systematic literature review

Frequent emergency department use in the paediatric population: A systematic literature review

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non‐randomised, concurrent mixed methods study protocol

Optimizing Experimental Simulation Design for the Emergency Departments

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