Making the Case for Nurse Practitioners in the Emergency Department: A Clinical Case Study.

Emergency departments (EDs) across the country are inundated with patients and they struggle to provide the expected standard of care while meeting set benchmarks. A shortage of emergency medicine physicians further complicates the situation, and many facilities are utilizing nurse practitioners to bridge the gap. A clinical case study was conducted at Touro Infirmary, a large urban hospital in New Orleans, LA, to provide an in-depth look at the implementation and positive outcomes of nurse practitioners in one ED. The model used at this facility included a nurse practitioner in the "fast track" area of the ED as well as a nurse practitioner in triage. Overall, the door-to-provider time decreased from 59.25 min in 2012 to 32.08 min in 2013. The bed-to-provider time decreased by an average of 9.17 min, with a 22.92-min average seen in 2012 and a 13.75-min average seen in 2013. An average decrease of 18.3 min was seen in the overall length of stay from 2012 to 2013. The percentage of left without treatment dropped by 3.77%, from 5.07% in 2012 to 1.3% in 2013. In addition to the improved statistics, an increase in the number of patients was also seen. The number of daily visits increased by an average of 2.25 patients per day or 51.4 patients per month. The acuity of the patients did not change, with an average admission rate of 21% noted in both 2012 and 2013. Patient satisfaction remained high at more than 90% during both years. The percentage of significant returns also remained constant at less than 1% in both 2012 and 2013. Assessment of the CMS (Centers for Medicare & Medicaid Services) Quality Measures and PRQS (Physician Quality Reporting System) Indicators do not reveal any change of statistical significance. The average of all providers was shown to be at or above the benchmark set for each measurement/indicator.