BMJ Open. 2019 Jul 30;9(7):e024529. doi: 10.1136/bmjopen-2018-024529.
To evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators.
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.
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.
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.
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.
评估澳大利亚公立医院急诊部（ED）中护士从业者（NP）服务对服务和患者安全及质量指标的影响。
这项队列研究包括 2013 年 7 月至 2014 年 6 月期间，对随机抽取的医院的 ED 就诊情况（按州/地区和大都市与非大都市位置分层）进行了评估；并对 ED 再次就诊的医疗记录进行了回顾性审核。
使用逻辑回归和 Cox 比例风险回归比较了有 NP 和无 NP 的 ED 之间的服务指标数据（澳大利亚分诊量表 2、3、4 和 5 类患者的等待时间；无需等待的患者人数；非住院患者的 ED 停留时间），并对医院和患者特征以及医院内结果的相关性进行了调整。使用泊松回归比较了随机亚组再次就诊的安全和质量指标数据（ED 非计划再次就诊率）。
在 66 个 ED 中，有 55 个（83%）提供了 2463543 例 ED 患者就诊的服务指标数据，有 58 个（88%）提供了 2853 例 ED 再次就诊的安全和质量指标数据。与无 NP 的 ED 相比，有 NP 的 ED 的等待时间显著（p<0.001）更长。就诊于有 NP 的 ED 的患者在 ED 中多花费了 13 分钟（8%）（中位数（第一四分位数-第三四分位数）：有 NP 的 ED 为 156（93-233）分钟，无 NP 的 ED 为 143（84-217）分钟）。有 NP 的 ED 有 1.8%的患者无需等待，但再次就诊率与有 NP 的 ED 相似。
有 NP 的 ED 在服务指标方面表现较差。然而，这些发现应该谨慎对待。NP 在 ED 工作人员中相对较新，NP 人数较少、人员配置模式和仍在发展的角色可能限制了他们对服务指标的影响。需要进一步研究来解释 NP 在个体临床结果研究中表现出的优势与这些宏观系统观察到的优势之间的二分法。
