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

Abstract

BackgroundHealth reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities.MethodsThis study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care.ResultsThe median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models.ConclusionsThere was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2395-9) contains supplementary material, which is available to authorized users.

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review

“…at the point of the search. The previously unpublished manuscript was subsequently published in 2017 [ 42 ]. All included studies were conducted between 2006 and 2016.…”

Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies

“…APN involves: “nurses working in advanced roles have additional training and work beyond RNs' scope of practice?” (Maier & Aiken, ). In previous research, researchers have found advanced practice nursing to be as good as or, in some cases, even better than physician‐led care (Cooper, Lindsay, Kinn, & Swann, ; Roche, Gardner, & Jack, ; Wilson, Zwart, Everett, & Kernick, ). Nurse‐led care has been shown to have a positive impact on wait times (Hiza, Gottschalk, Umpierrez, Bush, & Reisman, ; Jennings, Clifford, Fox, O'Connell, & Gardner, ), patient satisfaction (Cooper et al, ; Jennings et al, ; Martinez‐Gonzalez et al, ), and quality of care (Jennings et al, ; Martinez‐Gonzalez et al, ).…”

“…(Maier & Aiken, 2016). In previous research, researchers have found advanced practice nursing to be as good as or, in some cases, even better than physician-led care (Cooper, Lindsay, Kinn, & Swann, 2002;Roche, Gardner, & Jack, 2017;Wilson, Zwart, Everett, & Kernick, 2009).…”

Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application

“…In a small emergency department in Australia, 61 patients were examined by physicians with the help of emergency nurses, and the waiting time and length of stay were calculated as 13.2 min and 116 min, respectively. Nevertheless, no evidence is provided in terms of comparisons with other situations related to these parameters in the research [19].The purpose of this study is to ensure that nurses recommended for ESs in Turkey are employed as advanced nurses (ANs) after receiving 2+ years of training, after they complete a normal nursing education. ANs must have the authority to write prescriptions for routine diseases (colds, headaches, Processes 2019, 7, 48 3 of 18…”

“…In a small emergency department in Australia, 61 patients were examined by physicians with the help of emergency nurses, and the waiting time and length of stay were calculated as 13.2 min and 116 min, respectively. Nevertheless, no evidence is provided in terms of comparisons with other situations related to these parameters in the research [19].…”