Evaluation of the Impact of Emergency Advanced Practice Nurses One Year After Implementation in the Adult Emergency Department of a French University Hospital

Evaluation of the Impact of Emergency Advanced Practice Nurses One Year After Implementation in the Adult Emergency Department of a French University Hospital - A Monocentric Cross-sectional Observational Study

In France and around the world, emergency care facilities are facing increasing demand, with rising waiting times. Differentiating care pathways, notably by opening a fast-track unit, helps to improve patient flow and waiting time; which contributes to patient satisfaction. However, a link between patient satisfaction and waiting time is not always found when patients perceive a humanistic approach in care.

The implementation of an advanced practice nurse in an emergency department is a way to graduate the offer of care and reduce waiting times before consultation and length of stay for patients with minor degree of severity. In this care context, Advanced Practice Nurses maintain and even improve patient satisfaction.

Since July 2024, two Advanced Practice Nurses have integrated Poitiers University Hospital's adult emergency department. Considering the existing and ongoing literature to knowledge, an evaluation of the impact of emergency Advanced Practice Nurses 1 year after their implementation in a French University Hospital would be the first study of its kind.

According to the results of previous international studies, the investigators assume that emergency Advanced Practice Nurses activities have a positive impact on the French healthcare system: on the quality of care perceived by patients and on the emergency care pathways of all fast-track patients by maintaining the same level of safety. This study aims to evaluate the impact of emergency Advanced Practice Nurses in a French University Hospital on patient perception of quality of care, safety and patient care pathways in emergency departments.

This monocentric cross-sectional observational study is a prospective survey of patient satisfaction and experience with a satisfaction questionnaire; and a retrospective survey on routine care data.

The study's main objective is to evaluate the impact of emergency Advanced Practice Nurses in a French University Hospital on patient-perceived quality of care by measuring the overall satisfaction of patients who receive care from Advanced Practice Nurses during their emergency care pathway. Overall patient satisfaction will be measured in a survey conducted with a patient satisfaction and experience questionnaire.

The secondary objectives of this study are several:

• Assess patients' acceptability of being cared by an emergency Advanced Practice Nurse
• Evaluate patient satisfaction with the communication and care relationship with an emergency Advanced Practice Nurse
• Evaluate the rate of recommendation of an emergency Advanced Practice Nurse by the patients who receive care from an Advanced Practice Nurse
• Evaluate the safety of care pathways including an emergency Advanced Practice Nurse
• Evaluate the impact of emergency Advanced Practice Nurses implementation on emergency care pathways for fast-track patients

Consistent with each objective and outcome, the study will compare:

• groups before and after the implementation of emergency Advanced Practice Nurses
• or subgroups in the period after implementation of advanced practice nurses: with and without emergency Advanced Practice Nurses intervention The anonymous patient satisfaction and experience survey will be sent by a link in a verified e-mail during the emergency department visit of patients included in the study, admitted to emergency department between 02/06/2025 and 29/06/2025.

Routine care data will be collected from Poitiers hospital medical records for fast-track patients who did not refuse to take part in the study during the following periods:

• Before Advanced Practice Nurses' implementation from 05/27/2024 to 06/23/2024
• After Advanced Practice Nurses' implementation from 02/06/2025 to 29/06/2025

Inclusion Criteria:

• Patient arrived in fast-track unit during Advanced Practice Nurses' attendance periods
• Adult over or equal 18 years old

Exclusion Criteria:

• Patient who refused to participate to the research
• Patient deprived of total or partial liberty by a judicial or administrative decision
• Patients under guardianship or trusteeship
• Patient with diagnosed cognitive disorders
• Non-French-speaking patient
• Patients who left without waiting for treatment or against medical advice