The Development of Practice Guidelines for Advanced Practice Clinicians in the Emergency Departments Staffed by the Utah Emergency Physicians

The emergency departments (EDs) staffed by the Utah Emergency Physicians (UEP) are faced with unique challenges. Intermountain Medical Center (IMC) and McKay-Dee Hospital are often faced with long door to provider times and an increased length of stay (LOS) for patients due to the high volume of patients that seek care. Alta View Hospital (AVH), LDS Hospital and Riverton Hospital often have department surges where staffing another physician is not cost effective but another independent provider would be helpful in caring for patients. The EDs staffed by UEP do not currently utilize APCs. Increased wait times and LOS in EDs have several consequences. The consequences include poor patient outcomes, greater patient suffering, a decrease in patient satisfaction, an increase in the number of patients who leave without treatment and an increase in anger and violence towards healthcare workers. The purpose of this project is threefold: to research the current roles of APCs in the ED, to develop clinical practice guidelines for the roles of APCs in the EDs staffed by UEP and to present the clinical practice guidelines to the UEP Executive Committee. There are millions of Americans without access to healthcare. A lack of access to primary and preventative healthcare results in an increase in ED visits. The ED is the only aspect of the health care system that is mandated by federal law to screen, and if necessary, treat all patients who seek care. Nationally, 64% of EDs use APCs. From 1993 to 2009, the number of patients seen by an APC increased from 4.1% to 14.5%. Current roles of APCs in the ED include using the APC as a ‘Provider in Triage', in ‘Caring for Specific Chief Complaints', in a ‘Collaborative Model of Care', in ‘Fast Track Units' and in ‘Observational Units'. Through a review of the literature, collaboration with content experts and site visits to hospitals that currently utilize APCs, I identified the current roles of APCs in the ED to facilitate the development of practice guidelines. The guidelines developed included using the APC in a combination of a ‘Provider in Triage' role and in a ‘Collaborative Model of Care' role at IMC and McKay Dee Hospital and in a ‘Collaborative Model of Care' at AVH, LDS and Riverton Hospitals. Final implementation included presentation to the UEP Executive Committee. The large percentage of ED visits that are classified as urgent or semi-urgent suggests that APCs are ideally suited to provide care to the vast majority of ED patients. This will lead to a decrease in LOS, a decrease in patients who leave without treatment, a decrease in anger and violence towards care givers and ultimately an increase in patient satisfaction and patient outcomes.