Introducing handheld computers into home care.

In the fall of 2009, Bayshore Home Health (BHH) provided tablet computers to 75 home care nurses working in Barrie, Ont. The devices were equipped with an embedded evidence-based documentation system and loaded with decision-making supports such as drug reference databases. The technology was designed to facilitate client assessment, care planning and evaluation at the point of care. This article documents the experience of implementing handheld computers in a home care setting and presents the lessons learned from the perspectives of the BHH executive team and front-line nurses. These groups were asked to complete online surveys, developed by the BHH research and evaluation steering committee, to assess the impact of the implementation on the organization, its nurses and its clients. An analysis of the feedback indicated support for the implementation. However, both groups had concerns about the capability of the hardware and software to meet the needs of decentralized home care nurses working in both urban and rural areas. Front-line nurses also identified the impact of handheld computers on the time required for charting and on the nurse-client relationship as areas of concern.

Impact of a nurse practitioner on patient care in a Canadian emergency department.

OBJECTIVE: Our objective was to determine whether the addition of a broad-scope nurse practitioner (NP) would improve emergency department (ED) wait times, ED lengths of stay (LOS) and left-without-treatment (LWOT) rates. We hypothesized that the addition of a broad-scope NP during weekday ED shifts would result in shorter patient wait times, reduced LOS and fewer patients leaving the ED without treatment. METHODS: This prospective observational study was conducted in a busy urban free-standing community ED. Intervention shifts, with NP coverage, were compared with control shifts (similar shifts with emergency physicians [EPs] working independently). Primary outcomes included patient wait times, ED LOS and LWOT rates. Patient demographics, triage category, the provider seen, the time to provider and ED LOS were captured using an electronic database. RESULTS: The addition of an NP was associated with a 12% increase in patient volume per shift and a 7-minute reduction in mean wait times for low-acuity patients. However, overall patient wait times and ED LOS did not differ between intervention and control shifts. During intervention shifts, EPs saw a smaller proportion of low-acuity patients and there was a trend toward a lower proportion of LWOT patients (11.9% v. 13.7%, p = 0.10). CONCLUSION: Adding a broad-scope NP to the ED staff may lower the proportion of patients who leave without treatment, reduce the proportion of low-acuity patients seen by EPs and expedite throughput for a subgroup of less urgent patients. However, it did not reduce overall wait times or ED LOS in this setting.