Perceptions of Emergency Department Physicians Toward Collaborative Practice With Nurse Practitioners in an Emergency Department Setting

摘要

Once considered reserved for life-threatening disease or illness, emergency departments in the United States are now described as the primary care clinic and the social work department for many Americans (Grumback, Keane & Bindman, 1993). A 1992 study found 2 million children in the United States routinely used the emergency department as their primary source of care (Halfon, Newacheck, Wood & Peter, 1996). Studies have shown 50-90% of all patients presenting to emergency departments have minor complaints which could easily be treated in primary care settings (Dowling & Dudley, 1995; Grumbach et al., 1993) . The non-urgent use of emergency departments has led to overcrowding, long waiting times and patient dissatisfaction (Grumbach et al., 1993; Derlet & Nisho, 1990, Liggins, 1993). Overcrowding and inappropriate use of the emergency department also interferes with the care of critically ill patients (Dowling & Dudley, 1995). Civilian hospitals have developed various strategies to address patients with minor complaints varying from outright refusal of care, to triaging to off-site clinics, developing non-urgent care clinics and establishing Fast Track Clinics also known as Minor Emergency Areas (MEAs) within existing emergency departments. These Fast Track clinics have been staffed with a variety of non-physician, mid-level health care providers including nurse practitioners.