None listed
Conditions
Brief summary
The overall aims of this study were to examine the effectiveness of the rural ENP service model. Specific aims were to: i) Examine the safety and quality of the ENP service model in the provision of care in the rural environment, and ii) Evaluate the effectiveness of ENP service in the management of patients presenting with undifferentiated chest pain. In order to achieve the study aims we investigated several outcomes in order to address the following research questions: * What are the health service structures that influence the ENP delivery of safe, quality care for patients presenting to rural EDs with chest pain? * Are the processes of care for patients who present to rural EDs with chest pain equivalent for patients managed by an ENP service to those managed in the standard model of care? * Are the comparative outcomes for patients who present to rural EDs with chest pain equivalent for patients managed by an ENP service to those managed in the standard model of care? To address the research questions the following null hypotheses were tested: Hypothesis One – Primary outcome For patients presenting to rural emergency departments with suspected or confirmed acute coronary syndrome who are managed by the ENP service or standard medical care, there will be no difference in: (i) Use of evidence based guidelines for management of care as measured by the extent to which this is demonstrated in the clinical record and, (ii) Diagnostic accuracy as measured by accuracy of electrocardiogram (ECG) interpretation. Hypothesis Two For patients presenting to rural emergency departments with undifferentiated chest pain who are managed by an ENP or standard medical care, there will be no difference in: (i) Service indicators of a. Median waiting times b. Overall Length-of-stay in the emergency department for all patients presenting with chest pain c. Did-not-wait rates (ii) Diagnostic accuracy as measured by rates of unplanned representation within seven-days Hypothesis Three For patients presenting to rural emergency departments with undifferentiated chest pain who are managed by ENP service or standard care there will be no difference in levels of patient-reported outcomes related to: i) Satisfaction with care ii) Quality-of-Life (QoL) iii) Functional status
Interventions
The independent variable is the service model involved in the management of patients presenting with undifferentiated chest pain - either ENP service or standard care model. In both models all clinicians work collaboratively and within their designated scope of practice.
For the purpose of this study the ENP model is operationally defined as follows:
* Emergency nurse practitioner model: The ENP manages the patient presenting with undifferentiated chest pain. The ENP delivers and coordinate
The independent variable is the service model involved in the management of patients presenting with undifferentiated chest pain - either ENP service or standard care model. In both models all clinicians work collaboratively and within their designated scope of practice. For the purpose of this study the ENP model is operationally defined as follows: * Emergency nurse practitioner model: The ENP manages the patient presenting with undifferentiated chest pain. The ENP delivers and coordinated care in the diagnosis, investigation, therapeutic treatment (including prescribing of medications and technical interventions) and referral. In this model ED nursing staff work with the ENP in providing nursing care to the patient. As this research is an observational study, there will be no allocation of intervention; rather the care delivery model will follow the standard method of patient allocation. The current practice at these facilities involves the use of the Australasian Triage Scale to ensure that patients are treated in order of clinical urgency. The next available clinician (ENP or medical officer) is responsible for providing care to patients in order of clinical urgency. Medical and ENP service is provided in and out of hours. At the index presentation, presenting patients who meet the inclusion criteria will be identified by the triage nurse or the treating clinician and invited to participate in the study. Participation in this research will involve the completion of a patient questionnaire at baseline, the researcher’s use of routinely collected data and completion of follow-up patient questionnaire. Potential participants will receive information and consent package, explaining the purpose of the research and procedures involved in completing the study. Trained research assistants will explain the study, enrol eligible consenting patients and assist with the completion of a baseline questionnaire. Patients will be advised that they may decline to engage in the study or withdraw from participation at any time without disadvantage. Follow-up patient data was collected once only at 30-days after the initial presentation to ED.
Sponsors
Queensland University of Technology
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients with chest pain who present participating EDs during the data collection period will be eligible for recruitment, if they: 1. Are at least 18-years old; 2. Have chest pain that is not the result of an acute injury; Are capable (or have a legally acceptable representative) of providing informed consent
Exclusion criteria
Traumatic chest pain; not able to provide consent
Outcome results
None listed