Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-18T08:54:10.023Z Has data issue: false hasContentIssue false

A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department

Published online by Cambridge University Press:  21 May 2015

Alix J.E. Carter*
Affiliation:
Section of Emergency Medicine, Yale University, New Haven, Conn. Section of Emergency Medicine, University of Manitoba, Winnipeg, Man.
Alecs H. Chochinov
Affiliation:
Section of Emergency Medicine, University of Manitoba, Winnipeg, Man. St. Boniface General Hospital, Winnipeg, Man.
*
Yale University Section of Emergency Medicine, 464 Congress Ave., Suite 260, New Haven CT 06519; alix.carter@yale.edu

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%–80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs).

Methods:

We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness.

Results:

Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking.

Conclusion:

The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.

Type
Education • Éducation
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Dowling, D, Dudley, WN. Nurse practitioners: meeting the ED’s needs. Nurs Manage 1995;26:48c-e.Google Scholar
2.Geolot, D, Alongi, S, Ediich, RF. Emergency nurse practitioner: an answer to an emergency care crisis in rural hospitals. JACEP 1977;6:355–7.Google Scholar
3.Henderson, K. Telemergency: distance emergency care in rural emergency departments using nurse practitioners. J Emerg Nurs 2006;32:388–93.CrossRefGoogle ScholarPubMed
4.James, MR, Pyrgos, N. Nurse Practitioners in the accident and emergency department. Arch Emerg Med 1989;6:241–6.Google Scholar
5.Weiss, JP. Using the nurse practitioner in the acute care setting. Aspens Advis Nurse Exec 1994;9:46.Google Scholar
6.Herman, J. Acute care nurse practitioner: past present and future. S C Nurse 1999;6:17.Google Scholar
7.Law, H, Sloan, J. Doctor’s Assistants- do we need them? J Accid Emerg Med 1999;16:114–6.Google Scholar
8.Le-Mon, B. The role of the nurse practitioner. Nurs Stand 2000; 14:4951.CrossRefGoogle ScholarPubMed
9.Hollinger-Smith, L, Murphy, MP. Implementing a residency program for the acute care nurse practitioner. MedSurg Nursing 1998 Feb;7:2833, 36–8.Google ScholarPubMed
10.Beales, J. Innovation in accident and emergency management: establishing a nurse practitioner-run minor injuries/primary care unit. Accid Emerg Nurs 1997;5:71–5.CrossRefGoogle ScholarPubMed
11.Sidani, S, Irvine, D. A conceptual framework for evaluating the nurse practitioner role in acute care settings. J Adv Nurs 1999;30:5866.Google Scholar
12.Crinson, I. Impact of the patients charter on A&E departments 2: the emergency nurse practitioner. Br J Nurs 1995 Dec 14-1996 Jan 11;4(22):1321–5.CrossRefGoogle Scholar
13.Walsh, M. The emerging role of the nurse practitioner in A&E. Emerg Nurse 2000;7:20–4.CrossRefGoogle Scholar
14.Walsh, CR. The emergence of the acute care nurse practitioner. Cost Qual 2000;6:67.Google Scholar
15.Bland, A. Developing the emergency nurse practitioner in accident and emergency: a bottom up approach. Accid Emerg Nurs 1997;5:42–7.Google Scholar
16.CAEP working group on the future of emergency medicine in Canada. Can J Emerg Med 2002;4:431–8.Google Scholar
17.Estabrooks, C, Goel, V, Thiel, E, et al. Decision aids: are they worth it? A systematic review. J Health Serv Res Policy 2001;6:170–82.Google Scholar
18.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.CrossRefGoogle ScholarPubMed
19.Sakr, M, Angus, J, Perrin, J, et al. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomized controlled trial. Lancet 1999;354:1321–6.Google Scholar
20.Overton Brown, P, Anthony, D. Towards a partnership in care. J Adv Nurs 1998;27:890–6.Google Scholar
21.Chang, E, Daly, J, Hawkins, A, et al. An evaluation of the nurse practitioner role in a major rural emergency department. J Adv Nurs 1999;30:260–8.Google Scholar
22.Powers, MJ, Jalowiec, A, Reichelt, PA. Nurse practitioner and physician care compared for nonurgent emergency room patients. Nurs Pract 1984;9:39, 42,44–45.Google Scholar
23.Moser, MS. Attitude of emergency department patients with minor problems to being treated by a nurse practitioner. Can J Emerg Med 2004;6:246–52.CrossRefGoogle ScholarPubMed
24.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
25.Tachakra, S, Stinson, A. Emergency nurse practitioners should manage major cases. Emerg Nurse 2000;8:12–5.Google Scholar
26.Blunt, E. Role and productivity of nurse practitioners in one urban emergency department. J Emerg Nurs 1998;24:234–9.Google Scholar
27.Lumb, E. Successful ED nurse practitioner group advocates more general nurse practitioner programs. J Emerg Nurs 1994;20:78.Google Scholar
28.Brebner, JA, Ruddick-Bracken, H, Norman, JN, et al. The nurse practitioner: management of minor trauma. Accid Emerg Nurs 1996;4:43–6.CrossRefGoogle ScholarPubMed
29.Considine, J, Martin, R, Smit, D, et al. Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department. Int J Nurs Pract 2006;12:205–13.Google Scholar
30.Dolan, B. Nurse practitioners: the role in the accident and emergency and primary care. Nurs Stand 1997;11:33–8.CrossRefGoogle Scholar
31.Heaney, D, Paxton, F. Evaluation of a nurse led minor injuries unit. Nurs Stand 1997;12:35–8.Google Scholar
32.Tachakra, S, Deboo, P. Comparing the performance of ENPs and SHOs. Emerg Nurse 2001;9:36–9.Google Scholar
33.Walrath, JM, Levitt, MK, Styka, MA. Innovative emergency department group nurse practitioner practice. J Emerg Nurs 1984; 10:239–41.Google Scholar
34.Winston, S. Nurse Practitioners in the emergency department: a case study of the Washington Hospital Centre. Hosp Top 1981;59:10–3.CrossRefGoogle Scholar
35.Alongi, S, Geolot, D, Richter, L, et al. Physician and patient acceptance of emergency nurse practitioners. JACEP 1979;8:357–9.Google Scholar
36.Tye, CC, Ross, F, Kerry, SM. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey. J Accid Emerg Med 1998;15:31–4.Google Scholar
37.Cole, FL. Ramirez, E. Nurse practitioner autonomy in a clinical setting. Emerg Nurse 2000;7:2630.Google Scholar
38.Byrne, G, Richardson, M, Brunsdon, J, et al. An evaluation of the care of patients with minor injuries in emergency settings. Accid Emerg Nurse 2000;8:101–9.Google Scholar
39.Mabrook, AF, Dale, B. Can nurse practitioners offer a quality service? An evaluation of a year’s work of a nurse led minor injuries unit. J Accid Emerg Med 1998;15:266–8.Google Scholar
40.Mann, CJ, Grant, I, Guly, H, Hughes, P. Use of the Ottawa Ankle Rules by nurse practitioners. J Accid Emerg Med 1998 Sep;15(5:)315–6.CrossRefGoogle Scholar
41.Meek, S, Kendall, J, Porter, J, et al. Can accident and emergency nurse practitioners interpret radiographs? A multicentre study. J Accid Emerg Med 1998;15:105–7.Google Scholar
42.Marshall, J, Edwards, C, Lambert, M. Administration of medicines by emergency nurse practitioners according to protocols in an accident and emergency department. J Accid Emerg Med 1997;14:223–7.Google Scholar
43.Morris, F, Head, S, Holkar, V. The nurse practitioner: help in clarifying clinical and educational activities in accident and emergency departments. Health Trends 1989;21:124–6.Google Scholar
44.Kirkwood, BJ, Pesudovs, K, Loh, RS, et al. Implementation and evaluation of an ophthalmic nurse practitioner emergency eye clinic. Clin Experiment Ophthalmol 2005;33:593–7.Google Scholar
45.Freij, RM, Duffy, T, Hackett, D, et al. Radiographic interpretation by nurse practitioners in a minor injuries unit. J Accid Emerg Med 1996;13:41–3.Google Scholar
46.Cooper, MA, Lindsay, GM, Kinn, S, et al. Evaluating emergency nurse practitioner services: a randomized controlled trial. J Adv Nurs 2002;40:721–30.Google Scholar
47.Banerjee, S, Beatty, S, Tyagi, A, et al. The role of ophthalmic triage and the nurse practitioner in an eye-dedicated casualty department. Eye 1998;12:880–2.Google Scholar
48.Ezra, DG, Mellington, F, Cugnoni, H, et al. Reliability of ophthalmic accident and emergency referrals: A new role for the emergency nurse practitioner? Emerg Med J 2005;22:696–9.CrossRefGoogle ScholarPubMed
49.Allerston, J, Justham, D. Nurse practitioners and the Ottawa Ankle Rules: comparisons with medical staff in requesting x-rays for ankle injured patients. Accid Emerg Nurs 2000;8:110–5.Google Scholar
50.Forgeron, P, Martin-Misener, R. Parents’ intentions to use pediatric nurse practitioner services in an emergency department. J Adv Nurs 2005;52:231–8.CrossRefGoogle ScholarPubMed
51.Byrne, G, Richardson, M, Brunsdon, J, et al. Patient satisfaction with emergency nurse practitioners in A&E. J Clin Nurs 2000;9:8392.CrossRefGoogle Scholar
52.Rhee, KJ, Dermyer, AL. Patient satisfaction with a nurse practitioner in a university emergency service. Ann Emerg Med 1995;26:130–2.CrossRefGoogle Scholar
53.Barr, M, Johnston, D, McConnell, D. Patient satisfaction with a new nurse practitioner service. Accid Emerg Nurs 2000;8:144–7.Google Scholar
54.Megahy, A, Lloyd, M. Managing minor injuries. Emerg Nurse 2004;12:14–6.Google Scholar
55.Considine, J, Martin, R, Smit, D, et al. Emergency nurse practitioner care and emergency department patient flow: case-control study. Emerg Med Australas 2006;18:385–90.Google Scholar