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BMC Health Serv Res. 2017 Jun 27;17(1):445. doi: 10.1186/s12913-017-2395-9.

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.

Author information

1
School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia. tina.roche@hdr.qut.edu.au.
2
Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia. tina.roche@hdr.qut.edu.au.
3
Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD, 4380, Australia. tina.roche@hdr.qut.edu.au.
4
Queensland University of Technology, Institute of Health and Biomedical Innovation Victoria Park Road, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
5
Emergency Department, Stanthorpe Health Services, PO Box 273, Stanthorpe, QLD, 4380, Australia.
6
Queensland University of Technology, School of Nursing Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.

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).

KEYWORDS:

Adherence to guidelines; Chest pain; Cohort; Emergency treatment; Nested cohort; Nurse practitioner; Patient satisfaction; Quality of care; Quality of life; Rural health services

PMID:
28655309
PMCID:
PMC5488347
DOI:
10.1186/s12913-017-2395-9
[Indexed for MEDLINE]
Free PMC Article

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