Nurse practitioners with independent practice can help improve emergency department quality measures

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Montana State University - Bozeman, College of Nursing


Emergency Departments (ED) across the United States continued to have an increase in patient visits, new interventions have been implemented to combat overcrowding. An Inland Northwest hospital continued to see an increase in low acuity patients and a decrease in the quality measure for timely and effective care. Therefore, ED management decided it was time to try to change its ED Nurse Practitioner (NP) policy to allow NPs independent practice in the ED triage for patients with low acuity complaints. Methods: A completed business plan was proposed to the ED provider (EDP) group to gain their support for NP independent practice for low acuity patients in the ED. The business plan proposed a 30-day Just-Do-It pilot project for a NP in triage during times of high patient census to evaluate, treat, and discharge the low acuity patients. Evaluation of the pilot project was completed by a before-and-after time series design using run charts to validate the changes in the quality measures left with being seen (LWBS), time to provider, and length of stay (LOS). Upon adoption of the business plan, the EDPs took their recommendation to the hospital's Medical Executive Committee and from there, to the hospital Credentialing Committee to request an official change in hospital policy. Results: Unfortunately, this ED went through a redesign and eliminated the traditional lobby triage before the proposal took place. Therefore, the project was revamped and only tried to get NP independent practice rights for NPs treating low acuity patients. However, due to the recent ED changes, and the increase in quality measures for timely and effective care related to the redesign, the ED providers and Credentialing did not accept NP independent practice. Conclusion: Though the literature and professional organizations supported independent practice for NPs in the ED for low acuity patients, the ED providers and the hospital Credentialing Committee did not see the need once the redesign showed an improvement in the quality measure of timely and effective ED care.




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