title: Impact of a nurse practitioner on patient care in a Canadian emergency department.
abstract: OBJECTIVE
  Our objective was to determine whether the addition of a broad-scope nurse practitioner (NP) would improve emergency department (ED) wait times, ED lengths of stay (LOS) and left-without-treatment (LWOT) rates. We hypothesized that the addition of a broad-scope NP during weekday ED shifts would result in shorter patient wait times, reduced LOS and fewer patients leaving the ED without treatment.
  
  
  METHODS
  This prospective observational study was conducted in a busy urban free-standing community ED. Intervention shifts, with NP coverage, were compared with control shifts (similar shifts with emergency physicians [EPs] working independently). Primary outcomes included patient wait times, ED LOS and LWOT rates. Patient demographics, triage category, the provider seen, the time to provider and ED LOS were captured using an electronic database.
  
  
  RESULTS
  The addition of an NP was associated with a 12% increase in patient volume per shift and a 7-minute reduction in mean wait times for low-acuity patients. However, overall patient wait times and ED LOS did not differ between intervention and control shifts. During intervention shifts, EPs saw a smaller proportion of low-acuity patients and there was a trend toward a lower proportion of LWOT patients (11.9% v. 13.7%, p = 0.10).
  
  
  CONCLUSIONS
  Adding a broad-scope NP to the ED staff may lower the proportion of patients who leave without treatment, reduce the proportion of low-acuity patients seen by EPs and expedite throughput for a subgroup of less urgent patients. However, it did not reduce overall wait times or ED LOS in this setting.
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada. ivan.steiner@ualberta.ca
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Steiner
authors.forename: Darren N
authors.initials: DN
authors.lastname: Nichols
authors.forename: Sandra
authors.initials: S
authors.lastname: Blitz
authors.forename: Lloyd
authors.initials: L
authors.lastname: Tapper
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Stagg
authors.forename: Leneela
authors.initials: L
authors.lastname: Sharma
authors.forename: Carla
authors.initials: C
authors.lastname: Policicchio
mesh_terms: D000328:Adult; D002170:Canada; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009722:Nurse Practitioners / Q000600:supply & distribution*; D009732:Nursing Care; D005791:Patient Care; D011446:Prospective Studies; D013997:Time Factors; D014505:Urban Population; D014850:Waiting Lists; D000078329:Workforce