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Are service and patient indicators different in the presence or absence of nurse practitioners? the EDPRAC cohort study of Australian emergency departments

Middleton, Sandy, Gardner, Glenn, Gardner, Anne, Considine, Julie-Anne, FitzGerald, Gerard, Christofis, Luke, Doubrovsky, Anna, Della, Phillip, Fasugba, Oyebola and D'Este, Catherine 2019, Are service and patient indicators different in the presence or absence of nurse practitioners? the EDPRAC cohort study of Australian emergency departments, BMJ open, vol. 9, no. 7, doi: 10.1136/bmjopen-2018-024529.

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Title Are service and patient indicators different in the presence or absence of nurse practitioners? the EDPRAC cohort study of Australian emergency departments
Author(s) Middleton, Sandy
Gardner, Glenn
Gardner, Anne
Considine, Julie-AnneORCID iD for Considine, Julie-Anne orcid.org/0000-0003-3801-2456
FitzGerald, Gerard
Christofis, Luke
Doubrovsky, Anna
Della, Phillip
Fasugba, Oyebola
D'Este, Catherine
Journal name BMJ open
Volume number 9
Issue number 7
Total pages 11
Publisher BMJ Publishing
Place of publication London, Eng.
Publication date 2019-07
ISSN 2044-6055
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
QUALITY-OF-CARE
SATISFACTION
IMPACT
TIMES
MODEL
COST
emergency department
nurse practitioner
safety and quality indicator
service indicator
Summary © 2019 Author(s) (or their employer(s)). Objectives To evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators. Design and setting Cohort study comprising ED presentations (July 2013-June 2014) for a random sample of hospitals, stratified by state/territory and metropolitan versus non-metropolitan location; and a retrospective medical record audit of ED re-presentations. Methods Service indicator data (patient waiting times for Australasian Triage Scale categories 2, 3, 4 and 5; number of patients who did not-wait; length of ED stay for non-admitted patients) were compared between EDs with and without NPs using logistic regression and Cox proportional hazards regression, adjusting for hospital and patient characteristics and correlation of outcomes within hospitals. Safety and quality indicator data (rates of ED unplanned re-presentations) for a random subset of re-presentations were compared using Poisson regression. Results Of 66 EDs, 55 (83%) provided service indicator data on 2 463 543 ED patient episodes while 58 (88%) provided safety and quality indicator data on 2853 ED re-presentations. EDs with NPs had significantly (p<0.001) higher rates of waiting times compared with EDs without NPs. Patients presenting to EDs with NPs spent 13 min (8%) longer in ED compared with EDs without NPs (median, (first quartile-third quartile): 156 (93-233) and 143 (84-217) for EDs with and without NPs, respectively). EDs with NPs had 1.8% more patients who did not wait, but similar re-presentations rates as EDs with NPs. Conclusions EDs with NPs had statistically significantly lower performance for service indicators. However, these findings should be treated with caution. NPs are relatively new in the ED workforce and low NP numbers, staffing patterns and still-evolving roles may limit their impact on service indicators. Further research is needed to explain the dichotomy between the benefits of NPs demonstrated in individual clinical outcomes research and these macro system-wide observations.
Language eng
DOI 10.1136/bmjopen-2018-024529
Indigenous content off
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30132082

Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.