A Scoping Review of the Impact of Emergency Department Nurse Practitioners on Healthcare Outcomes in Canada Patient Safety Solution
Bibliographic record
Abstract
Background: Nurse Practitioners (NPs) are a valuable yet untapped resource in Canadian healthcare – especially in the emergency department (ED). Multiple international studies showed positive outcomes associated with NPs working in EDs, but limited Canadian studies are available. Aim: The objective of this study was to review the literature available in Canada on the outcomes associated with having NPs in the ED. These outcomes include wait times, length of stay (LOS), rates of patients who left without being seen (LWBS), willingness to be treated by an NP, and patient satisfaction with their treatment by an NP. Methods: This scoping review was informed by the procedures outlined by the Joanna Briggs Institute. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Two independent reviewers systematically searched CINAHL, EMBASE, SCOPUS, Cochrane Library, and MEDLINE in January 2022. All peer-reviewed articles that met the eligibility criteria were included. A pair of independent reviewers completed the selection process, screening, and data extraction. The reviewers discussed disagreements until they reached a consensus. Results: A total of five studies met the inclusion criteria. Decrease in wait times, LOS, rates of patients who LWBS, and increase in patient throughput were noted. One study did not find significant improvement in wait times, LOS, and rates of patients who LWBS. There was also a high rate of patient satisfaction and willingness to see an NP. Conclusion: This review shows evidence of positive change on the outcomes of decreased wait times, LOS, rates of patients who LWBS, and patient satisfaction associated with having NPs in EDs. However, there is limited up-to-date evidence in the Canadian literature leaving room for future research. Future research needs to address outcomes associated with NPs working in the ED in Canadian provinces other than British Columbia, Alberta, and Ontario, research that is more in line with the current political climate of the pandemic and lack of resources, and how NPs can be best integrated into EDs
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.047 | 0.165 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.040 | 0.051 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.008 | 0.004 |
| Open science | 0.004 | 0.004 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".