Charleston Area Medical Center, Charleston, West Virginia, USA.
Charleston Area Medical Center, West Virginia University Physicians of Charleston, Charleston, West Virginia, USA.
J Clin Nurs. 2023 Feb;32(3-4):517-522. doi: 10.1111/jocn.16300. Epub 2022 Mar 20.
The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow.
Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7.
Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines.
Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service.
The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300 min (772.25 ± 831.91 vs. 471.44 ± 336.65, p = <.001). Similarly, time to place emergency department discharge order was shorter by 49 min (277.76 ± 159.69 vs. 228.27 ± 116.04, p = .001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06 ± 0.23 vs. 1.46 ± 0.74, p < .001).
The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality.
Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.
本研究旨在评估创伤护士从业者 24/7 服务模式对急诊科患者流程的影响。
创伤患者在急诊科到住院医院护理之间的无缝过渡对于协调护理、临床安全和积极的健康结果至关重要。美国西弗吉尼亚州南部的一家一级创伤中心扩大了其创伤护士从业者服务范围，覆盖急诊科 24/7。
根据《加强观察性研究的报告流行病学指南》进行回顾性队列研究。
将 2019 年 3 月至 2020 年 2 月期间收入创伤中心的患者分为两组：接受创伤护士从业者管理的创伤患者与医院服务组。选择医院服务组作为对照组，因为在创伤护士从业者提供夜间服务之前的任何入院均由医院服务组管理。
创伤护士从业者组患者的急诊科停留时间显著缩短，平均缩短 300 分钟（772.25±831.91 分钟比 471.44±336.65 分钟，p<.001）。同样，放置急诊科出院医嘱的时间也缩短了 49 分钟（277.76±159.69 分钟比 228.27±116.04 分钟，p=.001）。此外，创伤护士从业者平均减少了一次会诊（1.06±0.23 次比 1.46±0.74 次，p<.001）。
创伤护士从业者提供的患者护理有助于减轻急诊科的压力。他们能够帮助促进患者流动，从而减轻过度拥挤的急诊科的压力。该研究机构希望维持当前的服务模式，并继续审查创伤护士从业者管理的结果和流程，以确保一致性和质量。
类似的创伤中心应评估其创伤服务结构，包括创伤护士从业者服务的角色，并努力使他们能够从急诊科 24/7 管理患者护理。
