title: Care of patients in emergency department waiting rooms--an integrative review.
abstract: OBJECTIVE
  To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms.
  
  
  BACKGROUND
  Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated.
  
  
  METHODS
  Integrative review.
  
  
  METHODS
  Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014.
  
  
  METHODS
  Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings.
  
  
  RESULTS
  Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care.
  
  
  CONCLUSIONS
  Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives.
authors.affiliation: Faculty of Health, University of Technology Sydney, New South Wales, Australia.|Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia.
authors.forename: Kelli
authors.initials: K
authors.lastname: Innes
authors.affiliation: Faculty of Health, University of Technology Sydney, New South Wales, Australia.
authors.forename: Debra
authors.identifier: http://orcid.org/0000-0001-5252-5325
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Plummer
authors.affiliation: Faculty of Health, University of Technology Sydney, New South Wales, Australia.
authors.forename: Doug
authors.identifier: http://orcid.org/0000-0002-6081-5442
authors.initials: D
authors.lastname: Elliott
mesh_terms: D017598:Efficiency, Organizational; D016529:Emergency Nursing / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000458:organization & administration*; D013996:Time and Motion Studies
keywords: advanced practice; emergency department; emergency nursing; extended practice; integrative review; literature review; waiting room