The Influence of a Nurse Practitioner on Out of Hours Work Intensity for Surgical House Officers

Henderson, Nicola; Cookson, Daniel; Plumley, Robert; Cairns, Melinda; Paterson-Brown, Simon

doi:10.1177/003693309904400208

Cited by 7 publications

(6 citation statements)

References 1 publication

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“…2,3,14,15,21,23,27,30,31 It is important that we critically examine the effect that these changes have on the hospital work environment, and most importantly on patient care, before advocating widespread adoption.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,[19][20][21][22][23][24][25] The main effects documented included a decrease in overall resident work hours, increased operating room time, reduced number of pages, increased time for educational activities and increased sleep time. Victorino and Organ 22 demonstrated decreased resident workload and stress levels and improved resident morale after the addition of PEs.…”

Section: Effect On Residentsmentioning

confidence: 99%

“…Several studies have demonstrated that the addition of PEs to surgical services helps to accomplish those goals. 7,9,19,[21][22][23][24][25] Fewer pages and administrative duties have also been shown to increase resident sleep time and to reduce resident workload and stress levels, which may further maximize residents' educational opportunities. Some institutions in Canada have increased the number of clinical fellows to address resident shortages.…”

Section: Included Studies 29mentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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Background: With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. Methods:We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles.Results: Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs. Conclusion:The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.Contexte : Compte tenu de la réduction du nombre d'heures de travail des médecins résidents et de la pénurie de stagiaires qui en a résulté, une solution à long terme s'impose pour assurer la sécurité et l'efficacité des soins aux patients. Une solution consiste à intégrer des infirmières praticiennes (IP) et des adjoints aux médecins (AM) dans divers contextes de soins de santé. Nous avons voulu examiner l'incidence du recours aux IP et aux AM dans des services de chirurgie et de traumatologie et son effet sur la santé des patients et sur la charge de travail des médecins résidents.

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Section: Discussionmentioning

confidence: 99%

Section: Effect On Residentsmentioning

confidence: 99%

Section: Included Studies 29mentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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“…5 NPPs in surgery particularly are valuable in allowing residents operating room time. Studies have shown that NPPs decrease the workload of residents, 6,7 while providing benefits to patients and hospitals, including a shortened length of stay. 8,9 The Mount Sinai Surgical Residency program in New York City is currently composed of 72 residents.…”

Section: Introductionmentioning

confidence: 99%

Non-Physician Practitioners’ Overall Enhancement to a Surgical Resident’s Experience

Buch

Genovese

Conigliaro

et al. 2008

Journal of Surgical Education

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“…Some studies however studied the effects of the use of nurses for the telephone triage or telephone consultations [34,35]. Others, studied the effects of the use of NPs in a hospital setting [36,37] and the effectiveness of emergency care practitioners (ECP) in a primary care out of hours service [38,39]. Nevertheless, it is unknown if nurse practitioners are also useful to perform face to face consultations in a primary out of hours setting.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

et al. 2012

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BackgroundIn many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting.DesignA quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012.MethodsData will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators.DiscussionThe study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting.Trial registrationClinicalTrials.gov ID NCT01388374

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The Influence of a Nurse Practitioner on Out of Hours Work Intensity for Surgical House Officers

Cited by 7 publications

References 1 publication

Physician extenders on surgical services: a systematic review

Physician extenders on surgical services: a systematic review

Non-Physician Practitioners’ Overall Enhancement to a Surgical Resident’s Experience

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

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