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The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

Published online by Cambridge University Press:  21 May 2015

James Ducharme ,
Robert J. Alder ,
Cindy Pelletier ,
Don Murray  and
Joshua Tepper
James Ducharme*
Affiliation:
Department of Medicine, McMaster University, Hamilton, Ont.
Robert J. Alder
Affiliation:
Department of Medicine, McMaster University, Hamilton, Ont.
Cindy Pelletier
Affiliation:
MedEmerg International Ltd., Mississauga, Ont.
Don Murray
Affiliation:
Harry Cummings and Associates, Guelph, Ont.
Joshua Tepper
Affiliation:
Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
*
9-6400 Millcreek Dr., Mississauga ON L5N 3E7; jducharme@medemerg.com

Abstract

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Objective:

We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs).

Methods:

We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status.

Results:

Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively.

Conclusion:

The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

Keywords

emergency departmentphysician assistantnurse practitionerwait timeslength of stay
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 5 , September 2009 , pp. 455 - 461
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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