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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; Fitzgerald, Gerard J; Christofis, Luke; Doubrovsky, Anna; Della, Phillip; Fasugba, Oyebola; D'Este, Catherine

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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...[Show more]

dc.contributor.authorMiddleton, Sandy
dc.contributor.authorGardner, Glenn
dc.contributor.authorGardner, Anne
dc.contributor.authorConsidine, Julie
dc.contributor.authorFitzgerald, Gerard J
dc.contributor.authorChristofis, Luke
dc.contributor.authorDoubrovsky, Anna
dc.contributor.authorDella, Phillip
dc.contributor.authorFasugba, Oyebola
dc.contributor.authorD'Este, Catherine
dc.date.accessioned2020-06-04T01:34:40Z
dc.date.available2020-06-04T01:34:40Z
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/1885/204814
dc.description.abstractObjectives 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.
dc.description.sponsorshipThis study was funded by the Australian Research Council (LP140100320) and industry partners (Office of the Chief Nursing and Midwifery Officer, Queensland Health; Clinician Planning and Leadership Unit, Queensland Health; Nursing and Midwifery Office, SA Health; Nursing and Midwifery Office, NSW Health; Chief Nurse and Midwifery Officer, Department of Health and Human Services, Victoria; Nursing and Midwifery Office, Department of Health, Western Australia).
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherBMJ Publishing Group
dc.rights© Author(s) (or their employer(s)) 2019
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.sourceBMJ Open
dc.titleAre service and patient indicators different in the presence or absence of nurse practitioners? the EDPRAC cohort study of Australian emergency departments
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume9
dc.date.issued2019
local.identifier.absfor111709 - Health Care Administration
local.identifier.ariespublicationu3102795xPUB5349
local.publisher.urlhttps://authors.bmj.com/open-access/
local.type.statusPublished Version
local.contributor.affiliationMiddleton, Sandy, Australian Catholic University
local.contributor.affiliationGardner, Glenn, Queensland University of Technology
local.contributor.affiliationGardner, Anne, Queensland University of Technology
local.contributor.affiliationConsidine, Julie, Deakin University
local.contributor.affiliationFitzgerald, Gerard J, Queensland University of Technology
local.contributor.affiliationChristofis, Luke, Lyell McEwin Hospital
local.contributor.affiliationDoubrovsky, Anna, Queensland University of Technology
local.contributor.affiliationDella, Phillip, Curtin University
local.contributor.affiliationFasugba, Oyebola , Australian Catholic University
local.contributor.affiliationD'Este, Catherine, College of Health and Medicine, ANU
dc.relationhttp://purl.org/au-research/grants/arc/LP140100320
local.bibliographicCitation.issue7
local.identifier.doi10.1136/bmjopen-2018-024529
local.identifier.absseo920206 - Health Inequalities
dc.date.updated2019-12-19T07:19:39Z
local.identifier.scopusID2-s2.0-85070874546
dcterms.accessRightsOpen Access
dc.provenanceThis is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
dc.rights.licenseCreative Commons Attribution Non Commercial (CC BY-NC 4.0)
CollectionsANU Research Publications

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