title: Evaluating emergency nurse practitioner service effectiveness on achieving timely analgesia: a pragmatic randomized controlled trial.
abstract: OBJECTIVE
  The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia.
  
  
  METHODS
  Patients presenting with pain were randomly assigned to receive either standard ED medical care or NP care. Primary investigators were blinded to treatment allocation for data analyses. The primary outcome measure was the proportion of patients receiving analgesia within 30 minutes from being seen by care group. Secondary outcome measures were time to analgesia from presentation and documentation of and changes in pain scores.
  
  
  RESULTS
  There were 260 patients randomized; 128 received standard care (medical practitioner led), and 130 received NP care. Two patients needed to be excluded due to incomplete consent forms. The proportion of patients who received analgesia within 30 minutes from being seen was 49.2% (n = 64) in the NP group and 29.7% (n = 38) in the standard group, a difference of 19.5% (95% confidence interval [CI] = 7.9% to 31.2%; p = 0.001). Of 165 patients who received analgesia, 64 (84.2%) received analgesia within 30 minutes in the NP group compared to 38 (42.7%) in the standard care group, a difference in proportions of 41.5% (95% CI = 28.3% to 54.7%; p < 0.001). The mean (±SD) time from being seen to analgesia was 25.4 (±39.2) minutes for NP care and 43.0 (±35.5) minutes for standard care, a difference of 17.6 minutes (95% CI = 6.1 to 29.1 minutes; p = 0.003). There was a difference in the median change in pain score of 0.5 between care groups, but this was not statistically significant (p = 0.13).
  
  
  CONCLUSIONS
  Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.
authors.affiliation: School of Nursing & Institute of Health & Biomedical Innovation, Queensland University of Technology, Queensland, Australia.|Emergency and Trauma Centre, The Alfred Hospital, Victoria, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Jennings
authors.affiliation: School of Nursing & Institute of Health & Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Victoria, Australia.|Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Victoria, Australia.|Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data*; D001315:Australia; D003142:Communication; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D059408:Pain Management / Q000706:statistics & numerical data*; D010147:Pain Measurement; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult