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Observation Medicine: The Expanded Role of the Nurse Practitioner in a Pediatric Emergency Department Extended Care Unit

Silvestri, Antonette MSN, CRNP; McDaniel-Yakscoe, Noreen MSN, CRNP

doi: 10.1097/01.pec.0000161467.35089.f4
Nursing Forum

Background: The use of observational units (OUs) in pediatric emergency departments (EDs) has become an important adjunct to emergency care. An extended observation period (4 to 23 hours) in the ED has decreased both the number of admissions and prolonged use of acute ED beds. This serves to increase patient satisfaction as well as optimizing care. The use of OUs allows for the most appropriate allocation of resources. These units are typically located within the ED or immediately adjacent to it. The ED physicians are the gatekeepers of the unit and serve as the medical supervision for these patients. The Children's Hospital of Philadelphia developed an OU known in the hospital as the Emergency Department Extended Care Unit (EDECU) approximately 5 years ago. In order for the EDECU to function at its fullest potential, the ED at The Children's Hospital of Philadelphia has opted to use the ED nurse practitioners (NPs) to enhance the care for these patients.

Objective: The NP has been an integral member of the ED for the past 10 years with primary roles in urgent care and in the follow-up program. As the ED expanded to include the EDECU, the role of the NP also developed to meet the needs of these patients. A review of the role development of the ED NP in observation medicine and the impact on patient and staff satisfaction as well as contributing to fiscally responsible care will be addressed.

Methods: A retrospective review of the NP's role development in the evolution of the EDEDU.

Results: Incorporation of the NP in the treatment team has provided efficient use of professional staff, comprehensive patient care, and increased patient satisfaction.

Conclusions: The use of the EDECU has become an important part of the services offered in the ED at The Children's Hospital of Philadelphia. The integration of the NP in a pivotal role allows for optimal use of human resources, and provides efficient, cost-effective patient care in the ED.

The Children's Hospital of Philadelphia, Philadelphia, PA.

Nursing Forum Editorial Board

Senior Editor

Kate O'Neill, RN, MSN

Wilmington, Delaware

Darlene Bradley, MSN, RN, PhDc, CNS, CCRN, CEN

Artwood, California

Harriet Hawkins

Oak Park, Illinois

Reneé Holleran, PhD, RN

Salt Lake City, Utah;

Pam Burke, PhD, RN, PNP, FNP

Boston, Massachussetts

Susan Hohenhaus, RN, MA

Columbia, South Carolina

Patricia Kunz Howard, RN, MSN, CEN, PhDc

Lexington, Kentucky

Address correspondence and reprint requests to Antonette Silvestri, MSN, CRNP, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.