Background: Health reforms in service improvement have included the use of nurse practitioners. In rural\nemergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities\nincluding those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the\neffectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and\nquality of the service, particularly regarding the management of complex conditions is a priority to ensure that this\nservice improvement model meets health care needs of rural communities.\nMethods: This study used a prospective, longitudinal nested cohort study of rural emergency departments in\nQueensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November\n2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or\nconfirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and\ndiagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included\nservice indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction\nwith care, quality-of-life, and functional status. Data were examined and compared for differences for participants\nmanaged by emergency nurse practitioners and those managed in the standard model of care.\nResults: The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were\n2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority\nof participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day\nfollow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were\ncomparable with previous studies. No differences were demonstrated between service models. Conclusions: There was a high level of adherence to clinical guidelines for the emergency nurse practitioner\nservice model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated\ncomparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient\nreported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse\npractitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations.\nTrial registration: Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).
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