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Impact of a nurse practitioner on patient care in a Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Ivan P. Steiner ,
Darren N. Nichols ,
Sandra Blitz ,
Lloyd Tapper ,
Andrew P. Stagg ,
Leneela Sharma  and
Carla Policicchio
Ivan P. Steiner*
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Darren N. Nichols
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Sandra Blitz
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Lloyd Tapper
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Andrew P. Stagg
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Leneela Sharma
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
Carla Policicchio
Affiliation:
Departments of Family Medicine and Emergency Medicine, University of Alberta, Edmonton, Alta
*
205 College Plaza, 8215 — 112 St., Edmonton AB T6G 2C8; ivan.steiner@ualberta.ca

Abstract

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Objective:

Our objective was to determine whether the addition of a broad-scope nurse practitioner (NP) would improve emergency department (ED) wait times, ED lengths of stay (LOS) and left-without-treatment (LWOT) rates. We hypothesized that the addition of a broad-scope NP during weekday ED shifts would result in shorter patient wait times, reduced LOS and fewer patients leaving the ED without treatment.

Methods:

This prospective observational study was conducted in a busy urban free-standing community ED. Intervention shifts, with NP coverage, were compared with control shifts (similar shifts with emergency physicians [EPs] working independently). Primary outcomes included patient wait times, ED LOS and LWOT rates. Patient demographics, triage category, the provider seen, the time to provider and ED LOS were captured using an electronic database.

Results:

The addition of an NP was associated with a 12% increase in patient volume per shift and a 7-minute reduction in mean wait times for low-acuity patients. However, overall patient wait times and ED LOS did not differ between intervention and control shifts. During intervention shifts, EPs saw a smaller proportion of low-acuity patients and there was a trend toward a lower proportion of LWOT patients (11.9% v. 13.7%, p = 0.10).

Conclusion:

Adding a broad-scope NP to the ED staff may lower the proportion of patients who leave without treatment, reduce the proportion of low-acuity patients seen by EPs and expedite throughput for a subgroup of less urgent patients. However, it did not reduce overall wait times or ED LOS in this setting.

Keywords

nurse practitioneremergency carequality assuranceemergency departmentemergency physician
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 3 , May 2009 , pp. 207 - 214
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

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