title: Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain: protocol for a multicentre, longitudinal nested cohort study.
abstract: BACKGROUND
  Chest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and supported clinicians in the delivery of safe and effective care, including the use of emergency nurse practitioners (ENPs). Despite increasing use of ENPs, little is known about the safety and quality of the service in the rural ED context. The aims of this study are (1) to examine the safety and quality of the ENP service model in the provision of care in the rural environment and (2) to evaluate the effectiveness of the service in the management of patients presenting with undifferentiated chest pain.
  
  
  METHODS
  This is the protocol for a prospective longitudinal nested cohort study to compare the effectiveness of ENP service with that of standard care. Adults presenting to three rural EDs in Queensland, Australia with a primary presenting complaint of atraumatic chest pain will be eligible for enrolment. We will measure (1) clinician's use of evidence-based guidelines (2) diagnostic accuracy of ECG interpretation for the management of patients with suspected or confirmed ACS (3) service indicators of waiting times, length-of-stay and did-not-wait rates and (4) clinician's diagnostic accuracy as measured by rates of unplanned representation within 7 days (5) satisfaction with care, (6) quality-of-life and (7) functional status. To assess these outcomes we will use a combination of measures collected from routinely collected data, medical record review and questionnaires (with 30-day follow-up).
  
  
  BACKGROUND
  Queensland Health Human Research Ethics Committee (HREC) has approved this protocol. The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.
authors: Stanthorpe Health Services, Emergency Department, Stanthorpe, Queensland, Australia School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia.
authors: Tina E
authors: TE
authors: Roche
authors: School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia.
authors: Glenn
authors: http://orcid.org/0000-0002-7999-7872
authors: G
authors: Gardner
authors: School of Nursing, Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia.
authors: Peter A
authors: PA
authors: Lewis
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000328:Adult; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment; D006780:Hospitals, Rural; D006801:Humans; D008137:Longitudinal Studies; D009722:Nurse Practitioners; D011446:Prospective Studies; D011793:Queensland; D012107:Research Design; D012424:Rural Population; D059039:Standard of Care; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: ACCIDENT & EMERGENCY MEDICINE; STATISTICS & RESEARCH METHODS