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ACEM Spring Symposium
ACEM Spring Symposium
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Emergency Nurse Practitioner’s disposition decision accuracy compared to Plastic Surgery Registrars for Emergency Department presentations

Presentation Description

Emergency Nurse Practitioners (ENPs) are a stable, qualified and reliable medical workforce substitution for low acuity presentations and improve the patient experience.
To demonstrate the accuracy of ENP disposition decisions when compared to the plastics surgery registrar for common plastics presentations.
Prospective study with convenience sample recruitment of patients presenting from 0800-midnight (ENP working hours) and assessed exclusively by an ENP whose disposition decision was then compared to the plastics registrar.
342 patients were recruited. Most were male, (72%), adult (81%), had presentations related to the fingers or hand (82%) and managed by an ENP with less than 10 years of experience (65%). Accuracy of disposition decisions of ENPs compared to the plastic surgery registrar were high (80%). When DC-RFA and ADMIT subgroups were combined, given ENPs lacked knowledge of ward or OT availability, accuracy increased to 88%. Disposition agreement measured by Cohen’s Kappa for all patients was 0.72 but improved to 0.84 with DC-RFA and ADMIT combined. For those requiring operative management, accuracy was 94% with an agreement of 0.85. (Table 2) For hand and finger presentations, disposition agreement was 0.72 but increased to 0.86 with DC-RFA and ADMIT combined. Overall median ED length of stay (EDLOS) was 189 minutes (IQR 122–277 mins). Shorter EDLOS occurred when discharged from hospital to GP or Clinic, in finger injuries or when an ENP had greater than 10 years of experience. 
ENPs have high accuracy in disposition decisions when compared to medical counterparts.