Utilization of Nurse Practitioners for Procedural Sedation in a Pediatric Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/162978
Type:
Presentation
Title:
Utilization of Nurse Practitioners for Procedural Sedation in a Pediatric Emergency Department
Abstract:
Utilization of Nurse Practitioners for Procedural Sedation in a Pediatric Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Wood, Charene, BSc, RN, BSN, MS, CS-PNP
P.I. Institution Name:Women and Children's Hospital of Buffalo
Title:Pediatric Nurse Practitioner/ Professor
Contact Address:219 Bryant Street, Buffalo, NY, 14222, USA
Contact Telephone:(416) 415-5000
Co-Authors:Colleen Hurley, PNP; Julie Wettlaufer, FNP; Michelle Penque, MD; Kathleen Lillis, MD; Steve Shaha, PhD
Purpose: Nurse practitioners have practiced in primary care settings for years and more recently have been incorporated into emergency departments. In 1995, nurse practitioners were introduced into our pediatric emergency department (PED). In June 2002, the nurse practitioner (NP) role was expanded to include administration and management of procedural sedation and analgesia (PSA) in a highly independent practice model. The purpose of this study was to determine if utilization of nurse practitioners decreased overall length of stay (LOS) for patients in the pediatric emergency department without increasing the complication rate. Design: This was a retrospective study using exhaustive chart review. Setting: The study was conducted at a pediatric emergency department of an urban, teaching, regional pediatric trauma center. Sample: All cases up to 21 years of age who presented to the pediatric emergency department between May 1, 2001 and April 30, 2004 and who required PSA were included in the chart review. Methodology: The retrospective chart review was conducted for children who underwent PSA, which was defined as two or more agents. Data collected included time of triage, time seen by nurse practitioner or physician, time of sedation, time of discharge, total LOS in the pediatric emergency department, NP involvement, medications given, patient diagnosis, and complications. Results: Results substantiated statistically significant advantages to NP management of PSA. Of the 693 cases that were reviewed, 77.4% were treated by physicians, 17.7% were treated by nurse practitioners, and 4.9% involved transfer of care between physicians and nurse practitioners. LOS in the pediatric emergency department and time to sedation were both significantly lower for NP-managed cases than for physician cases across all diagnoses (p < .001). There were no significant differences between nurse practitioners and physicians regarding: (a) time to contact with practitioner, (b) medications utilized, and (c) diagnoses treated. NP time values remained significantly lower than physicians' time values for the two-year period after nurse practitioners were fully implemented for PSA in the emergency department. There were no significant differences in complication rates, and neither nurse practitioner nor physician management of procedures required advanced airway management. Conclusions: Overall LOS and time to sedation were significantly improved when nurse practitioners independently managed patients requiring PSA in the emergency department. Nurse practitioners used the same medications as physicians and incurred no significantly higher rates of complications.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleUtilization of Nurse Practitioners for Procedural Sedation in a Pediatric Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162978-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Utilization of Nurse Practitioners for Procedural Sedation in a Pediatric Emergency Department</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Wood, Charene, BSc, RN, BSN, MS, CS-PNP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Women and Children's Hospital of Buffalo</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Pediatric Nurse Practitioner/ Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">219 Bryant Street, Buffalo, NY, 14222, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(416) 415-5000</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">charenewood@hotmail.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Colleen Hurley, PNP; Julie Wettlaufer, FNP; Michelle Penque, MD; Kathleen Lillis, MD; Steve Shaha, PhD<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: Nurse practitioners have practiced in primary care settings for years and more recently have been incorporated into emergency departments. In 1995, nurse practitioners were introduced into our pediatric emergency department (PED). In June 2002, the nurse practitioner (NP) role was expanded to include administration and management of procedural sedation and analgesia (PSA) in a highly independent practice model. The purpose of this study was to determine if utilization of nurse practitioners decreased overall length of stay (LOS) for patients in the pediatric emergency department without increasing the complication rate. Design: This was a retrospective study using exhaustive chart review. Setting: The study was conducted at a pediatric emergency department of an urban, teaching, regional pediatric trauma center. Sample: All cases up to 21 years of age who presented to the pediatric emergency department between May 1, 2001 and April 30, 2004 and who required PSA were included in the chart review. Methodology: The retrospective chart review was conducted for children who underwent PSA, which was defined as two or more agents. Data collected included time of triage, time seen by nurse practitioner or physician, time of sedation, time of discharge, total LOS in the pediatric emergency department, NP involvement, medications given, patient diagnosis, and complications. Results: Results substantiated statistically significant advantages to NP management of PSA. Of the 693 cases that were reviewed, 77.4% were treated by physicians, 17.7% were treated by nurse practitioners, and 4.9% involved transfer of care between physicians and nurse practitioners. LOS in the pediatric emergency department and time to sedation were both significantly lower for NP-managed cases than for physician cases across all diagnoses (p &lt; .001). There were no significant differences between nurse practitioners and physicians regarding: (a) time to contact with practitioner, (b) medications utilized, and (c) diagnoses treated. NP time values remained significantly lower than physicians' time values for the two-year period after nurse practitioners were fully implemented for PSA in the emergency department. There were no significant differences in complication rates, and neither nurse practitioner nor physician management of procedures required advanced airway management. Conclusions: Overall LOS and time to sedation were significantly improved when nurse practitioners independently managed patients requiring PSA in the emergency department. Nurse practitioners used the same medications as physicians and incurred no significantly higher rates of complications.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:27Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:27Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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