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Evaluation of an advanced nurse practitioner led emergency rapid assessment and treatment service
Doireann Deay1, Orla O'Keefe1, Mary Byrne1
1Emergency Department, Tallaght University Hospital, Dublin, Ireland.
Background:
Emergency Departments (EDs) globally face persistent challenges, including overcrowding and workforce shortages, which negatively impact care quality and efficiency. Advanced Nurse Practitioners (ANPs) have demonstrated value in improving patient satisfaction, reducing wait times, and delivering cost-effective care. In Ireland, the ANP role is well-defined and regulated, supporting autonomous clinical practice.
Local Problem:
At Tallaght University Hospital (TUH), a significant proportion of ED presentations-abdominal pain, and chest pain was found to consume disproportionate clinical hours. A new ANP-led Emergency Rapid Assessment and Treatment (ERAT) service was introduced to target these low-acuity, high-contact-hour cohorts and alleviate ED pressures.
Method:
This service evaluation, conducted between September 2022 and April 2025, assessed ERAT's feasibility, safety, impact on ED process times, and patient satisfaction.
Results:
ERAT managed 2,518 patients, with no major adverse events or in-hospital deaths. Most patients (1,766, 74.8 %) were safely discharged. While overall ED length of stay did not differ, ERAT patients had significantly shorter clinician-to-discharge times (5.9 vs. 8.9 h, p < 0.05). Of the 56 abdominopelvic CT scans ordered, 42 scans (75 %) showed acute pathology. Eighty of the 85 (94.1 %) patients who completed a patient satisfaction questionnaire reported strong agreement that care met their expectations.
Conclusion:
The ERAT service is a feasible, safe, and patient-centred model for managing targeted ED presentations. Findings support ANP-led services as an effective strategy to enhance ED efficiency, optimize care delivery, and improve patient satisfaction in acute care settings.
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