The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments.
OBJECTIVE
We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs).


METHODS
We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status.


RESULTS
Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3-2.1, p < 0.05) and 2.1 (95% CI 1.6-2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%-39.0%, p < 0.01) and 48.8% (95% CI 35.0%-62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%-63%, p < 0.01) and 71% (95% CI 53%-96%, p < 0.05), respectively.


CONCLUSIONS
The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.
Department of Medicine, McMaster University, Hamilton, Ontario. jducharme@medemerg.com
James
J
Ducharme
Robert J
RJ
Alder
Cindy
C
Pelletier
Don
D
Murray
Joshua
J
Tepper
D004636:Emergency Service, Hospital; D017144:Focus Groups; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009722:Nurse Practitioners; D009864:Ontario; D010351:Patient Discharge / Q000706:statistics & numerical data; D010823:Physician Assistants; D012380:Role; D013997:Time Factors; D014850:Waiting Lists; D000078329:Workforce