1
|
Horvath S, Visekruna S, Kilpatrick K, McCallum M, Carter N. Models of care with advanced practice nurses in the emergency department: A scoping review. Int J Nurs Stud 2023; 148:104608. [PMID: 37801938 DOI: 10.1016/j.ijnurstu.2023.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes. METHODS This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles. RESULTS Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes. DISCUSSION Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries. TWEETABLE ABSTRACT Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.
Collapse
Affiliation(s)
- Samantha Horvath
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Sanja Visekruna
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | | | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
2
|
Gualandi R, Masella C, Viglione D, Tartaglini D. Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals. J Health Organ Manag 2021; ahead-of-print. [PMID: 32978906 DOI: 10.1108/jhom-11-2019-0316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions. DESIGN/METHODOLOGY/APPROACH This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed. FINDINGS When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality. RESEARCH LIMITATIONS/IMPLICATIONS This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings. PRACTICAL IMPLICATIONS Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery. ORIGINALITY/VALUE Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.
Collapse
|
3
|
Ahmadpour S, Bayramzadeh S, Aghaei P. Efficiency and Teamwork in Emergency Departments: Perception of Staff on Design Interventions. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:310-323. [PMID: 34128423 DOI: 10.1177/19375867211023156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study is twofold: (1) identifying design strategies that enhance efficiency and support teamwork in emergency departments (EDs) and (2) identifying design features that contribute to the spread of COVID-19, based on staff perception. BACKGROUND Due to increasing ED visits annually, an efficient work environment has become one of the main concerns in designing EDs. According to the literature, an efficient work environment and teamwork improve healthcare outcomes and positively impact staff satisfaction. During the COVID-19 pandemic, EDs faced various changes such as workflow and space usage. Few studies explored staff perceptions about the influence of design features on efficiency, teamwork, and the COVID-19 spread. METHOD An online survey with 14 open- and closed-ended questions was distributed among ED staff members to collect data about unit design features that impact efficiency, teamwork, and the COVID-19 spread. RESULTS The central nursing station was one of the preferred configurations that increased efficiency and teamwork in EDs. Decentralizing disposal rooms in small-size EDs and decentralizing the medication room in large-size EDs with more than 65 exam rooms can decrease staff walking steps. Flexibility to expand treatment spaces on demand, one-way track circulation path, and changing the air pressure in COVID-19 treatment areas were some of the staff suggestions for future EDs. CONCLUSION The findings of this study contribute to the body of knowledge that EDs' physical environments can impact efficiency and teamwork among staff and, consequently, healthcare outcomes. Compartmentalization of the ED layout can reduce the spread of COVID-19.
Collapse
Affiliation(s)
- Sahar Ahmadpour
- College of Architecture and Environmental Design, Kent State University, OH, USA
| | - Sara Bayramzadeh
- College of Architecture and Environmental Design, Kent State University, OH, USA
| | - Parsa Aghaei
- College of Architecture and Environmental Design, Kent State University, OH, USA
| |
Collapse
|
4
|
Wise S, Duffield C, Fry M, Roche M. Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team. HUMAN RESOURCES FOR HEALTH 2020; 18:17. [PMID: 32143632 PMCID: PMC7060538 DOI: 10.1186/s12960-020-0460-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/24/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. METHODS The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. RESULTS The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. CONCLUSION Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.
Collapse
Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- School of Nursing and Midwifery, Edith Cowan University, Australia, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
- Director Research and Practice Development Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, Kolling Building, St Leonards, NSW, 2065, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| |
Collapse
|
5
|
Chrusciel J, Fontaine X, Devillard A, Cordonnier A, Kanagaratnam L, Laplanche D, Sanchez S. Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study. BMJ Open 2019; 9:e026200. [PMID: 31221873 PMCID: PMC6588991 DOI: 10.1136/bmjopen-2018-026200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators. DESIGN Adjusted before-after analysis. SETTING A large hospital in the Champagne-Ardenne region, France. PARTICIPANTS Patients admitted to the ED between 13 January 2015 and 13 January 2017. INTERVENTION Implementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016). PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions. RESULTS The ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before-after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before-after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%. CONCLUSIONS The implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.
Collapse
Affiliation(s)
- Jan Chrusciel
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
- Department of Research and Public Health, University Hospitals of Reims, Reims, France
| | - Xavier Fontaine
- Emergency Department, Manchester Hospital, Charleville-Mézières, France
| | - Arnaud Devillard
- Emergency Department, Centre Hospitalier de Troyes, Troyes, France
| | - Aurélien Cordonnier
- Department of Medical Information, Manchester Hospital, Charleville-Mézières, France
| | - Lukshe Kanagaratnam
- Department of Research and Public Health, University Hospitals of Reims, Reims, France
- Faculty of Medicine, Université de Reims Champagne-Ardenne, Reims, France
| | - David Laplanche
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
| | - Stéphane Sanchez
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
| |
Collapse
|
6
|
Ryder M, Jacob E, Hendricks J. An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective. J Clin Nurs 2019; 28:2644-2658. [DOI: 10.1111/jocn.14853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/05/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Mary Ryder
- Edith Cowan University Joondalup Western Australia Australia
- University College Dublin Dublin Ireland
- St. Vincent’s University Hospital Dublin Ireland
| | - Elisabeth Jacob
- Edith Cowan University Joondalup Western Australia Australia
| | - Joyce Hendricks
- Edith Cowan University Joondalup Western Australia Australia
- Central Queensland University Brisbane Queensland Australia
| |
Collapse
|
7
|
Synthesis of Research Articles to Examine Reporting of the Educational Preparation and Practice Parameters of Emergency Nurse Practitioners. Adv Emerg Nurs J 2018; 40:226-237. [DOI: 10.1097/tme.0000000000000202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
|
9
|
Lutze M, Fry M, Mullen G, O’Connell J, Coates D. Highlighting the Invisible Work of Emergency Nurse Practitioners. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2017.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
10
|
Patient waiting time in hospital emergency departments of Iran: A systematic review and meta-analysis. Med J Islam Repub Iran 2017; 31:79. [PMID: 29445707 PMCID: PMC5804420 DOI: 10.14196/mjiri.31.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Waiting time in emergency department is a key indicator in measuring the quality of hospital services and has a significant impact on patient satisfaction The purpose of this study was to conduct a systematic review and meta-analysis of the patients' waiting time in hospital emergency departments in Iran. Methods: Data were collected from databases of Web of Science, Embase, PubMed, Scopus, Google scholar, SID, and Iran Medex using the following key words: "emergency ward", "emergency room", "waiting time", " time delay", "first visit", "first treatment" , "emergency department", "Iran", and their Persian equivalents. The timeframe of 2000 to 2016 was selected to search the articles. CMA 2 (Comprehensive Meta-Analysis) software was used in this meta-analysis. Results: A total of 236 articles were extracted from databases and other sources, and finally 17 articles were included in the analysis. In total, waiting time in different parts of the emergency department was measured for 15 943 patients. Mean±SD waiting time was 5.9 ± 0.6 minutes from the arrival to the first visit by a physician, it was 45 ± 5 minutes between the first visit and the first therapeutic steps, 94± 33.9 minutes between referring to the laboratory and receiving the result, 23.2 ± 3 minutes between referring to the radiology and receiving the result, and 32.2 ± 7 minutes between referring to ECG and receiving the result; moreover, waiting time for the first specialist consultation was 99.3 ± 32.8 minutes. Conclusion: The results demonstrated that waiting time in the emergency rooms of Iranian hospitals was higher than the national and international standards. According to the high rate of heterogeneity in the results and probability of publication bias, we highly recommend that readers use the results of this study and pay sufficient attention to this issue.
Collapse
|
11
|
Plath SJ, Wright M, Hocking J. Evaluating an australian emergency nurse practitioner candidate training program. ACTA ACUST UNITED AC 2017; 20:161-168. [DOI: 10.1016/j.aenj.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/27/2022]
|
12
|
Roche TE, Gardner G, Jack L. The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study. BMC Health Serv Res 2017; 17:445. [PMID: 28655309 PMCID: PMC5488347 DOI: 10.1186/s12913-017-2395-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. METHODS This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. RESULTS The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models. CONCLUSIONS There was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).
Collapse
Affiliation(s)
- Tina E. Roche
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD 4380 Australia
| | - Glenn Gardner
- Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
- Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD 4380 Australia
| | - Leanne Jack
- Queensland University of Technology, School of Nursing Victoria Park Road, Kelvin Grove, QLD 4059 Australia
| |
Collapse
|
13
|
Masso M, Thompson C. Australian research investigating the role of nurse practitioners: A view from implementation science. Collegian 2017. [DOI: 10.1016/j.colegn.2016.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Profiling wound management in the emergency department: A descriptive analysis. ACTA ACUST UNITED AC 2016; 19:166-71. [PMID: 27448461 DOI: 10.1016/j.aenj.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes. The aim of this study was to describe the discharge and referral status of adult patients presenting to one Australian emergency department with a wound, skin or ulcer condition. METHODS A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014. RESULTS A total of 4231 wound, skin and ulcer conditions were managed, accounting for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer. CONCLUSIONS Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.
Collapse
|
15
|
Saidi K, Paquet A, Goulet H, Ameur F, Bouhaddou A, Nion N, Riou B, Hausfater P. Effets de la création d’un circuit court au sein d’un service d’urgence adulte. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0593-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|