An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

AIMS AND OBJECTIVES: To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. BACKGROUND: Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. DESIGN: This descriptive study used a case-note review and a survey design with one open-ended exploratory question. METHODS: Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. RESULTS: Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. CONCLUSIONS: Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. RELEVANCE TO CLINICAL PRACTICE: This study provides some evidence to support the continued expansion of the emergency nurse practitioner service in rural settings in the UK.

Socioeconomic disparity in survival after breast cancer in ireland: observational study.

We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999-2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21-1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97-1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994-1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.