Nurse practitioner led short stay assessment units: an alternative model of care?
Aim The UK is undergoing a major reconfiguration of inpatient paediatric services. Recent guidelines encourage the development of short stay assessment units to increase patient/parent satisfaction and reduce burden on inpatient care. We wish to evaluate a novel 24-hour assessment unit whereby Paediatric Nurse Practitioners (PNPs) take the lead role in assessment and management with additional support provided by doctors.
Methods A prospective observational study of acute attendances to this short-stay assessment unit over four data collection periods was performed. Each period lasted one month and each season was included. Outcomes evaluated included: reason for attendance, length of stay, discharges, transfers to the offsite inpatient paediatric ward and re-attendance rates.
Results 270 acute attendances (mean age of 5 years, 23% < 1 year) were seen, with the majority (92%) being referred from the Emergency Department. The most common reasons for attendance included upper respiratory tract infections (19%), gastroenteritis (11%), viral illness (11%), head injury (10%) and asthma (9%). In addition, another 107 patients for planned reviews/investigations were also seen on the unit. The majority (65%) of acute patients spent less than 8 hours on the unit. The discharge rate was 76% with 21% transferred to offsite inpatient services. The remaining 3% included patients transferred to other services or those who died. Re-attendances within a week of discharge were 3%. No significant differences were found in discharge or re-attendance rates for patients seen by PNPs compared to doctors (75% v. 78%, p = 0.75; 2% v. 6%, p = 0.13 respectively).
Conclusion The data analysed are comparable to standard doctor-led units reported in the literature and would suggest that this model of care, with appropriate doctor involvement, could be a safe option for a short stay paediatric assessment unit. However to further determine the viability of such a unit, further research is recommended to ascertain cost-effectiveness and parent/staff satisfaction.