Emergency nurse practitioners: do they provide an effective service in managing minor injuries, compared to emergency medicine registrars?

AIM: To determine whether emergency nurse practitioners (ENPs) are as equivalent to emergency medicine (EM) registrars in minor injury management in a New Zealand environment. METHOD: A Prospective observational audit (chart review) of a non-consecutive cohort of patients with minor trauma was conducted. The primary outcome measure was length of stay. The secondary outcome measures were: time waiting to be seen, number of unexpected returns, missed injury rate and the number of patients who left the department without being seen. Data was analysed using standard statistical methods using Statview v5.0 (SAS) software. RESULTS: 420 patients were included; ENP group n=305, EM registrar group n=115.The ENPs, saw more males (70% versus 59%, p=0.03), younger (30 years versus 41 years, p=0.0004) and lower acuity patients (p<0.0001). After adjustment for age, gender and acuity, median ED length of stay was longer in EM registrar group by 40 minutes, p<0.0001, and the time to be seen was longer in the EM registrar group by 36 minutes, p<0.0001. Treatment times were equivalent. The missed fracture rate was 1% in both groups. The unexpected return rate was 2% in the ENP group and 1% in the EM registrar group. Left without being seen rate was 5%. CONCLUSION: ENPs appear to "sign on" to see minor injury patients faster than EM registrars, which may account for the reduced length of stay for ENP treated patients.

Emergency Department utilisation: a natural experiment.

AIM: In February 2005 a new Emergency Department (ED) was opened at Waitakere Hospital in West Auckland, New Zealand. Part of the rationale for this was the expectation that it would reduce attendances to the four established EDs in the Auckland region. This study was undertaken to determine whether this happened. METHOD: A retrospective analysis of ED presentations to Auckland City, Starship and North Shore hospitals for the 2 years prior to the opening of Waitakere ED (February 2005) was conducted. This was compared with the attendances to all hospitals in the 2 years following the opening of the new ED. The effect of the opening of Waitakere ED on ED presentations to other hospitals was assessed using control charts. Presentations to Middlemore Hospital during the same time period were used as a control. RESULTS: ED attendance to hospitals in the Auckland District Health Board (DHB) area increased by 9% over the study period (Auckland Hospital = 13%, Starship Children's Hospital = 2%), similarly ED attendance to Middlemore Hospital increased by 6%, consistent with population growth. However ED attendance to hospitals in the Waitemata DHB area (North Shore and Waitakere Hospitals) increased by 74%, disproportionate to population growth (8%). CONCLUSION: The opening of a new ED may have contributed to an increase in total ED presentations seen within the region overall, with no corresponding reduction in attendances at neighbouring hospitals.

Acute complications following extracorporeal shock-wave lithotripsy for renal and ureteric calculi.

Extracorporeal shock-wave lithotripsy remains a widely utilized treatment modality for renal and some ureteric calculi. The treatment is generally considered very safe. However, minor complications occur in a significant number of patients. Serious complications, causing ongoing morbidity or mortality, are rare, affecting less than 1% of patients. A review of the literature on the adverse effects of the treatment, with an emphasis on those which might present to ED is presented.

Impact on patients triage distribution utilizing the Australasian Triage Scale compared with its predecessor the National Triage Scale.

OBJECTIVE: To assess the impact of the change from the National Triage Scale (NTS) to the Australasian Triage Scale (ATS) within a hospital ED. METHODS: A retrospective audit of consecutive adult patients attending the ED of Auckland Hospital from July to September 2001, during which patients were triaged according to the NTS, were compared with patients triaged according to the ATS during July to September 2002. RESULTS: In total, 8715 patients attended the department during July to September 2001 compared with 9047 patients during July to September 2002. There was a significant shift in the triage ratios with patient number increases of 28 and 24% in triage categories two and three, respectively, and decreases of 15 and 67% in categories four and five, respectively. CONCLUSIONS: The revision of the ATS has had a significant impact on the triage distribution of patients who present to ED. The change of distribution might have implications for meeting performance criteria and assessing casemix.