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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

References

REFERENCES

1.Canadian Institute for Health Information. Understanding emergency department wait times: who is using the emergency departments and how long are they waiting? Ottawa (ON): The Institute; 2005. Available: http://dsp-psd.pwgsc.gc.ca/Collection/H118-31-2005E.pdf (accessed 2009 Jul 28).Google Scholar
2.Beveridge, R, Clarke, B, Janes, L, et al Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(3 suppl).Google Scholar
3.Physician Hospital Care Committee. Improving access to emergency care: addressing system issues. The Committee; 2006. Available: http://www.health.gov.on.ca/english/public/pub/ministry_reports/improving_access/improving_access.pdf (accessed 2009 Jul 28).Google Scholar
4.Mohsin, M, Forero, R, Ieraci, S, et al A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emerg Med J 2007;24:175–9.Google Scholar
5.Weiss, SJ, Arndahl, J, Ernst, AA, et al Development of a site sampling form for evaluation of ED overcrowding. Med Sci Monit 2002;8:CR549–53.Google Scholar
6.Bond, K, Ospina, MB, Blitz, S, et al Frequency, determinants, and impact of overcrowding in emergency departments in Canada: a national survey. Healthc Q 2007;10:32–40.Google Scholar
7.Defining the PA role in Ontario. Ontario physician assistant scope of practice statement and Ontario physician assistant competency profile. Toronto (ON): Health Force Ontario; 2007. Available: http://www.healthforceontario.ca/upload/en/work/defining%20the%20role%20of%20physician%20assistant%20scope%20of%20practice%20and%20competencies%20document_%20may%209%202007.pdf (accessed 2009 Jul 28).Google Scholar
8.College of Nurses of Ontario. Nurse practitioners standards of care. Toronto (ON): The College; 2008. Available: http://www.cno.org/docs/prac/41038_StrdRnec.pdf (accessed 2009 Jul 28).Google Scholar
9.Barr, M, Johnston, D, McConnell, D. Patient satisfaction with a new nurse practitioner service. Accid Emerg Nurs 2000;8:144–7.Google Scholar
10.Byrne, G, Richardson, M, Brunsdon, J, et al An evaluation of the care of patients with minor injuries in emergency settings. Accid Emerg Nurs 2000;8:101–9.Google Scholar
11.Rogers, T, Ross, N, Spooner, D. Evaluation of a ‘See and Treat’ pilot study introduced to an emergency department. Accid Emerg Nurs 2004;12:24–7.Google Scholar
12.Sakr, M, Kendall, R, Angus, J, et al Emergency nurse practitioners: a three-part study in clinical and cost effectiveness. Emerg Med J 2003;20:158–63.Google Scholar
13.Sanchez, M, Smally, AJ, Grant, RJ, et al Effects off a fast-track area on emergency department performance. J Emerg Med 2006;31:117–20.Google Scholar
14.Rodi, SW, Graw, MV, Orsini, CM. Evaluation of a fast track unit: alignment of resources and demand results in improved satisfaction and decreased length of stay for emergency department patients. QualManagHealth Care 2006;15:163–70.Google Scholar
15.Thrasher, C, Purc-Stephenson, R. Patient satisfaction with nurse practitioner care in emergency departments in Canada. J Am Acad Nurse Pract 2008;20:231–7.Google Scholar
16.Ardagh, M, Richardson, S. Emergency department overcrowding — Can we fix it? N Z Med J 2004;117:U774.Google Scholar
17.Bernstein, SL, Aronsky, D, Duseja, R, et al The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009;16:1–10.Google Scholar
18.Rudy, EB, Davidson, LJ, Daly, B, et al Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison. Am J Crit Care 1998;7:267–81.Google Scholar
19.Counselman, FL, Graffeo, CA, Hill, JT. Patient satisfaction with physician assistants (PAs) in an ED fast track. Am J Emerg Med 2000;18:661–5.Google Scholar
20.Venning, P, Durie, A, Roland, M, et al Randomized controlled trials comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ 2000;320:1048–53.Google Scholar