title: A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department.
abstract: BACKGROUND
  US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%-80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs).
  
  
  METHODS
  We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness.
  
  
  RESULTS
  Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking.
  
  
  CONCLUSIONS
  The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.
authors.affiliation: Section of Emergency Medicine, Yale University, New Haven, Connecticut 06519, USA. alix.carter@yale.edu
authors.forename: Alix J E
authors.initials: AJ
authors.lastname: Carter
authors.forename: Alecs H
authors.initials: AH
authors.lastname: Chochinov
mesh_terms: D003362:Cost-Benefit Analysis; D016529:Emergency Nursing / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014850:Waiting Lists; D000078329:Workforce