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Using Nurse Practitioners to Optimize Patient Flow in a Pediatric Emergency Department

Muller, Karen, RN, BSN, MHA*; Chee, Zoe, MN, NP; Doan, Quynh, MDCM, MHSc, PhD, FRCPC*†‡§

doi: 10.1097/PEC.0000000000000676
Original Articles

Objectives Using nurse practitioners (NPs) in pediatric emergency departments (PEDs) is commonplace in the United States, yet little is known on the impact of NPs on patient flow measures in these environments. This study quantifies the impact of NPs on 2 common measures of patient flow.

Methods We conducted a retrospective cohort study using administrative data from an academic tertiary care PED. Mean shift length of stay (LOS) and the daily proportion of patients leaving without being seen (LWBS) by a clinician were compared between shifts with and without NPs on duty, matched for external variables affecting the level of activity in the department. Multivariate regression analyses were also conducted to further adjust for covariates such as the total number of PED care providers, patient acuity distribution, and total volume seen in the ED.

Results Despite a slightly reduced total number of providers present on shifts with NPs on duty, a modest but statistically significant reduction in mean shift LOS (−19.11 minutes [95% confidence interval (CI), −31.01 to −7.22]) and daily proportion of LWBS (−1.11% [95% CI, −1.97% to −0.26%]) was observed for shifts with NPs compared with shifts without NPs on duty. Regression analyses showed that incremental NPs on shift were associated with a decreased LOS (−18.76 minutes [95% CI, −24.51 to −13.02]) as well as a reduced odds of LWBS (odds ratio, 0.56; 95% CI, 0.37–0.87).

Conclusions Nurse practitioners have a modest impact on patient flow measures in a PED and are a valuable resource to optimize patient flow.

From the *School of Population and Public Health, University of British Columbia;

British Columbia Children's Hospital;

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia; and

§Child and Family Research Institute, Vancouver, British Columbia, Canada.

Disclosure: The authors declare no conflict of interest.

Reprints: Quynh Doan, MDCM, MHSc, PhD, FRCPC, BCCH Emergency Department 4480 Oak St, Vancouver, BC V6H 3V4, Canada (e-mail:

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