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To provide a 10-year update on the best available evidence evaluating the impact of nurse practitioner services on cost, waiting times, patient satisfaction, representation rates, and length of stay in emergency and urgent care settings.
Systematic review.
The search was completed on January 28, 2025, in Embase (Elsevier), Medline (EBSCOhost), CINAHL (EBSCOhost), Cochrane Library (Wiley), Emcare (Ovid), Web of Science Core Collection (Clarivate) and Scopus (Elsevier). The data range (2014–2024) was used to limit the search.
The search was conducted with results imported into Covidence. In Covidence, two reviewers conducted screening, data extraction, and quality appraisal of articles, and findings were analysed using a narrative synthesis approach. Eligible studies examined nurse practitioner services in emergency or urgent care settings, reporting outcomes of cost, waiting times, patient satisfaction, representation rates, and length of stay.
Title and abstract screening were performed on 2329 records. Of these, 236 full-text articles were reviewed, and 17 underwent critical appraisal and data extraction. Narrative analysis of outcome measures yielded mixed results, with both favourable and unfavourable findings reported regarding nurse practitioner services.
Global evaluation of nurse practitioner services in emergency care remains inconsistent. Nevertheless, emerging evidence supports their positive impact, particularly in improving patient outcomes. To effectively inform policy, workforce planning and clinical integration, there is a need for professional benchmarks that provide clear frameworks for the evaluation of patient-centred outcomes and operational impacts in emergency departments.
Evidence related to nurse practitioner services in emergency and urgent care clinics highlights the positive impact of nurse practitioner services on patient wait times and satisfaction; however, there is limited and variable evidence of impact on health care costs and outcomes.
This paper recommends that evaluating emergency nurse practitioner services requires homogeneous research using consistent professional benchmarks and evaluation frameworks.
This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
PROSPERO 2025 CRD420250645148.
Venous leg ulcers occur due to chronic venous insufficiency in the lower extremities and are often difficult to heal. Platelet-rich plasma and platelet-rich fibrin are products that contain high concentrations of platelets. This systematic review evaluated the effectiveness, safety and cost-effectiveness of these products for the treatment of venous leg ulcers. Guided by the 2020 Joanna Briggs Institute systematic review of effectiveness guideline, this review included original studies that investigated platelet-rich plasma and platelet-rich fibrin in the treatment of venous leg ulcers from databases including the Cochrane Library, Embase, Medline, CINAHL, PubMed, World Health Organisation International Clinical Trials Registry, Clinical Trials.gov and Australian New Zealand Clinical Trials Registry. Methodological quality was assessed using relevant appraisal checklists. Information related to general characteristics of included articles and relevant outcomes of interest were extracted and synthesised narratively. Of thirty-six eligible studies, 24 studies used platelet-rich plasma, eleven investigated fibrin-rich plasma and one study used both platelet-rich plasma and fibrin-rich. Most studies reported these products were effective in promoting wound healing, reducing other symptoms, and were safe to use. The use of platelet-rich plasma and platelet-rich fibrin resulted in significantly higher healed venous leg ulcers compared to control using conventional treatment (RR: 2.93, 95% CI, 1.90–4.53, p = 0.01). These products were safe to used topically and promoted to wound healing, reduced pain, either along or combined with other treatments. Platelet-rich plasma and fibrin-rich plasma improves wound healing and appears to be safe to use in the treatment of venous leg ulcers.
To evaluate whether implementing the Comprehensive Assessment and Risk Evaluation (CARE) record, developed to operationalise Standard 5: Comprehensive Care of the Australian National Safety and Quality Health Service Standards was associated with improvements in patient safety and quality of care. A secondary objective was to explore staff and patient experiences of implementation.
Mixed-methods pre–post evaluation combining quantitative analysis of routinely collected hospital data with staff surveys and patient interviews.
A metropolitan hospital network in Melbourne, Victoria, Australia
Quantitative analysis included 88 041 admissions pre-implementation and 23 765 post implementation. Staff surveys were completed by 117 staff (84% nurses, 60% with >5 years at the service). Structured interviews were conducted with 39 patients (mean age 65.6 years, 64% male).
The CARE record was a structured record embedding validated risk assessments (STRATIFY, Braden Scale, Malnutrition Screening Tool, Confusion Assessment Method/4 ‘A’s Test, Broset Violence Checklist, Columbia-Suicide Severity Rating Scale) and care planning into routine workflows, to meet requirements of Standard 5.
Primary outcomes were the incidence of falls and pressure injuries. Secondary outcomes were completion of the CARE record, staff and patient experiences, and documentation of other hospital-acquired complications (HACs) (delirium, malnutrition, violence and aggression, suicide and self-harm). Data were compared for two time periods: 1 January 2016 to 28 February 2019 (before CARE record implementation) and 1 March 2019 to 30 March 2020 (after CARE record implementation but before COVID-19).
Post implementation, overall falls decreased (OR 0.85; 95% CI 0.78 to 0.93), though severe falls increased (OR 1.89; 95% CI 1.17 to 3.07). Pressure injuries decreased in coded data (OR 0.41; 95% CI 0.23 to 0.73) and incident reports (OR 0.79; 95% CI 0.68 to 0.92). Documentation of delirium (OR 2.02), malnutrition (OR 2.03), aggression/violence (OR 2.09) and suicide/self-harm (OR 1.92) increased. Half of the staff (50.4%) felt they knew more about patients, but 61.2% reported more time to admit patients. Communication between nursing and allied health improved (65.8%). Patients were generally satisfied, though 50% repeated information frequently and 20% felt unprepared for discharge.
CARE record implementation, mandated by the Australian Commission on Safety and Quality in Health Care’s Standard 5, was associated with fewer pressure injuries and overall falls (though there was an increase in falls resulting in serious injury), and greater documentation of other complications. Staff and patient experiences highlighted some benefits but also documentation time challenges. Findings provide lessons for the national implementation of Standard 5 and the need to balance structured processes with clinical judgement.
Participation in physical activity (PA) is a cornerstone of the secondary prevention of stroke. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance capability and associated co-morbidity levels are recommended. Mobile health (mHealth) has been identified as a potential approach to supporting PA post-stroke. To this end, we used a Sequential Multiple Assignment Randomised Trial design to develop an adaptive, mHealth intervention to improve PA post-stroke – The Adaptive Physical Activity programme in Stroke (TAPAS) (Clinicaltrials.Gov NCT05606770). As the first trial in stroke recovery literature to use this design, there is an opportunity to conduct a process evaluation for this type of adaptive intervention. The aim of this process evaluation is to examine the implementation process, mechanism of change and contextual influences of TAPAS among ambulatory people with stroke in the community.
Guided by the Medical Research Council Framework for process evaluations, qualitative and quantitative methods will be used to examine the (1) implementation process and the content of TAPAS (fidelity adaptation, dose and reach); (2) mechanisms of change (participants’ response to the intervention; mediators; unexpected pathways and consequences) and (3) influence of the context of the intervention. Quantitative data will be presented descriptively, for example, adherence to exercise sessions. Qualitative data will be collected among TAPAS participants and the interventionist using semi-structured one-to-one or focus group interviews. Transcribed interviews will be analysed using reflexive thematic analysis. Key themes and sub-themes will be developed.
Ethical approval has been granted by the Health Service Executive Mid-Western Ethics Committee (REC Ref: 026/2022) (25/03/2024). The findings will be submitted for publication and presented at relevant national and international academic conferences.
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