title: Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia.
  
  
  BACKGROUND
  As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients.
  
  
  METHODS
  A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay.
  
  
  RESULTS
  Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p < 0.001)]. Length of stay in the ED was also significantly reduced in the ENPC group [median (IQR): ENPC 94 (53.5-163.5) minutes; TM 170 (100-274) minutes (Wilcoxon p < 0.001)]. The comparison of overall waiting times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p < 0.001)].
  
  
  CONCLUSIONS
  This study has demonstrated that ENPCs implementation in Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length of stay.
authors.affiliation: The Alfred Emergency and Trauma Centre, Prahran, Vic., Australia. n.jennings@alfred.org.au
authors.forename: Natasha
authors.initials: N
authors.lastname: Jennings
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.forename: Geraldine
authors.initials: G
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Belinda
authors.initials: B
authors.lastname: Free
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
mesh_terms: D004636:Emergency Service, Hospital; D009722:Nurse Practitioners; D024802:Nurse's Role; D017063:Outcome Assessment, Health Care; D011793:Queensland; D000078329:Workforce