Using Nurse Practitioners to Optimize Patient Flow in a Pediatric Emergency Department

Müller, Karen; Chee, Zoe; Doan, Quynh

doi:10.1097/pec.0000000000000676

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…Of note, we used a tighter threshold for considering possible clinically relevant differences in ED LOS than has been used in prior literature. When considering the effect of system changes on LOS for ED patients of every acuity level, +/- 30 minutes may be more appropriate as a threshold for clinically important changes to LOS 13,14. In conversations with our study team and clinicians who regularly work in our fast-track area, we chose a tighter clinically important difference threshold of 15 minutes because efficient care is especially important for low-acuity patients, given the relatively uncommon need for hospital admission, specialty consultation, or extensive diagnostic workups.…”

Section: Discussionmentioning

confidence: 99%

Paired analysis of ED efficiency for low-acuity children treated by PAs and pediatricians

McKinley¹,

Tran²,

Chamberlain³

et al. 2023

Jaapa

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Objective:To determine if there was a clinically important difference (15 minutes or more) in length of stay (LOS) for low-acuity pediatric ED patients treated by PAs compared with those treated by pediatricians.Methods:Between July 2017 and February 2020, shifts were identified that had shared PA and pediatrician staffing in the low-acuity care area for a large, urban ED. LOS was collected for every patient during the 6 hours of overlap for each shift. Using a paired analysis, we calculated the difference in mean LOS for these shifts.Results:Mean shift LOS for children seen by PAs (160.1 minutes, SD: 48.6) was 10.1 minutes longer (95% CI: 6.1, 14.1) than mean shift LOS for children seen by pediatricians (150 minutes, SD: 47.3).Conclusions:No clinically important difference in LOS was found for low-acuity children treated by PAs compared with those treated by pediatricians in a large, urban ED.

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Section: Discussionmentioning

confidence: 99%

Paired analysis of ED efficiency for low-acuity children treated by PAs and pediatricians

McKinley¹,

Tran²,

Chamberlain³

et al. 2023

Jaapa

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“…Intentional emergency medicine specialty education content provided during the orientation period for new providers or providers new to the specialty can accelerate the onboarding process and help NPs and PAs feel more confident in their new role (Ginde et al, 2010). This in turn leads to increased use of both NPs and physician assistants in optimizing flow in the ED, hence minimizing overcrowding (Doan et al, 2013(Doan et al, , 2014Muller et al, 2018;Nestler et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

A curriculum to improve knowledge and skills of nurse practitioners and physician assistants in the pediatric emergency department

Yusuf

Hagan

Stone

2022

J Am Assoc Nurse Pract

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Nurse practitioners (NPs) and physician assistants (PAs) have an important role in delivery of care in a tertiary children's hospital emergency department (ED). Most NPs and PAs have not had any formal training to work in a pediatric ED; although our NPs and PAs had no formal ED training, some were acute care certified. We describe a curriculum designed to improve knowledge and skills of NPs and PAs in the pediatric ED. The curriculum consists of three modules, namely, online lecture series, procedural workshops, and case scenarios in a simulated setting. Module 1 consisted of online lecture on 10 common ED diagnoses. The second module consisted of procedural workshops on lumbar puncture, incision and drainage of abscesses, gastrostomy insertion, and laceration repair. The third module included simulation scenarios on ED-specific cases of seizure in an infant, bronchiolitis and ruptured appendicitis with shock. Each module was evaluated by a survey. Participants rated each item on the survey using a Likert scale response (1 = disagree completely to 5 = agree completely). Both NPs and PAs demonstrated increase in knowledge scores in posttest 1 vs pretest (p < .001) and did not show a significant decline in posttest 2 (p = .073). The mean ratings of components of the online lecture series, workshops, and simulation scenarios were 4. 5-4.7, 4.4-4.8, and 4.5-4.7, respectively, with positive comments. This novel curriculum meets the educational needs of NPs and PAs at our institution and can be used as a model to train them at other tertiary care pediatric EDs.

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“…The process changes were based on previous research: implementing care by ENPs can reduce waiting times in the ED [11–13]. Involvement of medical specialists is associated with increased decisiveness resulting in decreased LOS [17].…”

Section: Discussionmentioning

confidence: 99%

“…In previous research, similar clinical redesign projects have been studied, including streaming patients directly from triage to dedicated minor injury units or super tracks [10] and ENP-led units [11–13], senior early assessment models of care [14–17], Lean methods [18–21], and improving access to inpatient admission [22]. Improving ED processes has been shown to reduce the length of stay (LOS), although studies show varying results, and the effect on crowding is uncertain [23].…”

Section: Introductionmentioning

confidence: 99%

The impact of a multimodal intervention on emergency department crowding and patient flow

Linden

Ufford²,

Linden

2019

Int J Emerg Med

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Objective The objective of this study is to assess the impact of a multimodal intervention on emergency department (ED) crowding and patient flow in a Dutch level 1 trauma center. Methods In this cross-sectional study, we compare ED crowding and patient flow between a 9-month pre-intervention period and a 9-month intervention period, during peak hours and overall (24/7). The multimodal intervention included (1) adding an emergency nurse practitioner (ENP) and (2) five medical specialists during peak hours to the 24/7 available emergency physicians (EPs), (3) a Lean programme to improve radiology turnaround times, and (4) extending the admission offices’ openings hours. Crowding is measured with the modified National ED OverCrowding Score (mNEDOCS). Furthermore, radiology turnaround times, patients’ length of stay (LOS), proportion of patients leaving without being seen (LWBS) by a medical provider, and unscheduled representations are assessed. Results The number of ED visits were grossly similar in the two periods during peak hours (15,558 ED visits in the pre-intervention period and 15,550 in the intervention period) and overall (31,891 ED visits in the pre-intervention period vs. 32,121 in the intervention period). During peak hours, ED crowding fell from 18.6% (pre-intervention period) to 3.5% (intervention period), radiology turnaround times decreased from an average of 91 min (interquartile range 45–256 min) to 50 min (IQR 30–106 min., p < 0.001) and LOS reduced with 13 min per patient from 167 to 154 min ( p < 0.001). For surgery, neurology and cardiology patients, LOS reduced significantly (with 17 min, 25 min, and 8 min. respectively), while not changing for internal medicine patients. Overall, crowding, radiology turnaround times and LOS also decreased. Less patients LWBS in the intervention period (270 patients vs. 348 patients, p < 0.001) and less patients represented unscheduled within 1 week after the initial ED visit: 864 (2.7%) in the pre-intervention period vs. 645 (2.0%) patients in the intervention period, p < 0.001. Conclusions In this hospital, a multimodal intervention successfully reduces crowding, radiology turnaround times, patients’ LOS, number of patients LWBS and the number of unscheduled return visits, suggesting improved ED processes. Further research is required on total costs of care and long-term effects.

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Using Nurse Practitioners to Optimize Patient Flow in a Pediatric Emergency Department

Abstract: Nurse practitioners have a modest impact on patient flow measures in a PED and are a valuable resource to optimize patient flow.

Cited by 7 publications

References 14 publications

Paired analysis of ED efficiency for low-acuity children treated by PAs and pediatricians

Paired analysis of ED efficiency for low-acuity children treated by PAs and pediatricians

A curriculum to improve knowledge and skills of nurse practitioners and physician assistants in the pediatric emergency department

The impact of a multimodal intervention on emergency department crowding and patient flow

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