Nurse practitioners in the emergency department: establishing a successful service

Background: A regional hospital emergency department was facing increasing patient presentations, medical workforce shortages and long delays for patients to be seen. Furthermore, a high percentage of low acuity ambulatory patients were not waiting to be seen. Aim: To introduce a sustainable / long-term nurse practitioner (NP) led model of care to address the identified emergency department service requirements for low acuity ambulatory patients. Methods: A descriptive exploratory design was used to establish and monitor a NP model. Organisational support and a steering committee was used to monitor clinical safety and patient satisfaction. Data was collected in relation to number of patients seen, conditions managed by nurse practitioners, time to treatment, length of stay and compliments and complaints received. Findings: NPs within this service now comprise 10% of the treating clinician workforce, see 15% of total presentations, contribute to a reduction in waiting time, length of stay within the targeted cohort and meeting National Emergency Access Targets 95% of the time. Discussion: Establishment of a NP model has been successful at addressing the needs of low acuity patients in the emergency department as evidenced by reduced waiting times, length of stay and customer satisfaction. We attribute this success to the following three key factors: targeting a patient population, commitment to the service and adaptability. Conclusion: Development of a dedicated NP model has enabled the emergency department to safely and sustainably provide care to low acuity ambulatory patients