Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.
"However, timely delivery of effective analgesia remains an ongoing challenge and the capacity of EDs to consistently deliver timely analgesia may be impacted by the increase in the number and complexity of presentations. ED overcrowding, access block, the growing number of chronic diseases in the community and reduced access to primary healthcare have all contributed to this increased demand for services (Lowthian and Cameron, 2012, Lowthian et al., 2011, Forero et al., 2010, Health Workforce Australia, 2012). "
[Show abstract][Hide abstract] ABSTRACT: Objectives
To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by measuring:
1) Evaluate time to analgesia from initial presentation
2) Evaluate time from being seen to next analgesia
3) Pain score documentation
The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance.
A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED Patient Information System (Cerner log) and data were extracted from electronic medical records
Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients that received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment.
The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.
International Emergency Nursing 07/2014; 23(2). DOI:10.1016/j.ienj.2014.07.002 · 0.72 Impact Factor
"Waiting times for care to be delivered in the emergency department is a key performance indicator of service efficiency used throughout contemporary emergency settings. Significantly increasing waiting times can have impacts on patient care with increased adverse events, mortality and hospital length of stay (Forero et al., 2010). Due to increasing service issues such as overcrowding, increased demand and the challenges of meeting time performance targets (National Health Performance Authority , 2013), emergency departments are focusing on the ability to deliver timely and efficient healthcare to patients. "
[Show abstract][Hide abstract] ABSTRACT: Aims
To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients.
The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services.
Data sources: A comprehensive search of four electronic databases from 2006-2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago.
Review methods: A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools.
Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis.
Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning.
International Journal of Nursing Studies 07/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.07.006 · 2.90 Impact Factor
"Emergency department overcrowding, access block, the growing burden of chronic diseases in the community, reduced access to primary health care have all contributed to increased demand in ED services (Sprivulis et al. 2006, Lowthian et al. 2011, Australian Health Workforce Association 2012). Emergency Department overcrowding is seen as the greatest single impediment to safe and efficient ED services in Australia and New Zealand (Cameron et al. 2009) significantly resulting in increasing waiting times, adverse events, mortality and hospital length of stay (Forero et al. 2010). National clinical indicators for ED service delivery are now government-mandated in several countries and designed to transparently monitor, analyse and evaluate a health service's performance (Department of Health United Kingdom 2011, Department of Health Victoria 2012). "
[Show abstract][Hide abstract] ABSTRACT: To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness.
Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care.
Pragmatic randomized controlled trial at one site with 260 participants.
This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours.
Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce.
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