UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS IN THE EMERGENCY DEPARTMENT

Even with the passing of new legislation relative to health care, it seems likely that emergency departments (ED) will continue to see large, increasing patient volumes. With the Patient Protection and Affordable Act (PPACA), there is anticipated influx of patients to the healthcare arena and consequently the ED. Improving triage, treatment protocols, and systems currently in place could reduce the strain of waiting in EDs and increase patient satisfaction. Like many modern EDs in the United States, the department at a large Catholic based southern California hospital (henceforth, “The Hospital”) has experienced significant increases in patient numbers over the past 10 years; it is anticipated this upward trend in patient volume will continue into the future. After reviewing the literature and critically observing the processes in The Hospital ED and several other EDs the outcomes of this project are a recommended new standard order set for the ED and a set of recommendations for personnel and process changes that will improve the throughput of the ED. The utilization of acute care nurse practitioners (ACNP) as part of an ED triage team is one such change. Other recommendations are using a pivot nurse, doing abbreviated triage, and having medical screening evaluations done and initial orders written in the triage area when all ED beds are full. Improving multiple aspects of the ED’s functioning, specifically, the front-end throughput, patient satisfaction, and federal metric scores.