Considine Julie, Lucas Elspeth, Payne Roslyn, Kropman Matthew, Stergiou Helen E, Chiu Herman
Deakin University - Northern Health Clinical Partnership, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.
Australas Emerg Nurs J. 2012 Nov;15(4):219-28. doi: 10.1016/j.aenj.2012.10.001.
There are many Emergency Department (ED) demand management systems that include advanced practice emergency nursing roles. The aim of this study is to examine and compare three advanced emergency nursing practice roles: ED Fast Track, Clinical Initiatives Nurse (CIN) and Rapid Intervention and Treatment Zone (RITZ).
A descriptive exploratory approach was used to conduct this study at an urban district hospital in Melbourne, Australia. The study participants were patients managed in each of the three systems with advanced practice emergency nursing roles: Fast Track, CIN and RITZ.
There were a total of 551 patients: 195 Fast Track patients, 163 CIN managed patients and 193 RITZ patients. CIN managed patients were older (p<0.001), with higher levels of clinical urgency (p<0.001), and higher hospital admission rates (p<0.001). CIN managed patients had shorter waiting time for nursing care (p=0.001) and lower incidence of medical assessment within the time associated with their triage category (p<0.0001). ED LOS for discharged patients was significantly longer for CIN managed patients (p<0.001). CIN managed patients had a significantly higher incidence of electrocardiography (p<0.001), blood glucose measurement (p<0.001), intravenous cannulation (p<0.001), pathology testing (p<0.001), and analgesia administration (p<0.001) when compared to Fast Track and RITZ patients.
Advanced practice roles in emergency nursing can have different applications in the ED context. Clarity about role intent and scope of practice is important and should inform educational preparation and teams within which these roles operate.
有许多急诊科（ED）需求管理系统，其中包括高级急诊护理角色。本研究的目的是检查和比较三种高级急诊护理实践角色：急诊快速通道、临床倡议护士（CIN）和快速干预与治疗区（RITZ）。
采用描述性探索性方法在澳大利亚墨尔本的一家市区医院开展本研究。研究参与者为在具有高级急诊护理角色的三个系统（快速通道、CIN和RITZ）中接受管理的患者。
共有551例患者：195例快速通道患者、163例由CIN管理的患者和193例RITZ患者。由CIN管理的患者年龄更大（p<0.001），临床紧急程度更高（p<0.001），住院率更高（p<0.001）。由CIN管理的患者接受护理的等待时间更短（p=0.001），在与其分诊类别相关的时间内进行医学评估的发生率更低（p<0.0001）。出院患者的急诊住院时间（ED LOS），由CIN管理的患者显著更长（p<0.001）。与快速通道和RITZ患者相比，由CIN管理的患者进行心电图检查（p<0.001）、血糖测量（p<0.001）、静脉置管（p<0.001）、病理检查（p<0.001）和给予镇痛（p<0.001）的发生率显著更高。
急诊护理中的高级实践角色在急诊环境中可有不同应用。明确角色意图和实践范围很重要，应为这些角色所在的教育准备和团队提供指导。
