Australasian Emergency Nursing Journal (2012) 15, 188—194

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/aenj

RESEARCH PAPER

Evaluating the quality of care delivered by an

emergency department fast track unit with both
nurse practitioners and doctors
Michael Dinh, MBBS, FACEM a,∗
Andrew Walker, MBBS b
Ahilan Parameswaran, MBBS c
Nicholas Enright, BPhys d

a
Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
b
Emergency Department Registrar, Royal Prince Alfred Hospital, Australia
c
Concord Hospital, Australia
d
Sydney Medical School, Sydney University, Australia

Received 8 June 2012; received in revised form 18 July 2012; accepted 4 September 2012

KEYWORDS Summary
Emergency Aims: This paper is a report of a study of quality of care delivered by an emergency department
department; fast track unit where both doctors and an emergency nurse practitioner treated patients.
Fast track; Background: Fast track units were established in Australian emergency departments to meet
Nurse practitioner; the needs of low complexity emergency department patients. Few studies have reported on
Quality of care the overall quality of care delivered by these units.
Methods: A convenience sample of adult patients triaged to an Australian emergency depart-
ment fast track unit between April 2010 and April 2011 were randomised to care by a doctor or
an emergency nurse practitioner. Quality of care was measured using patient satisfaction, follow
up health status using Short Form 12 and adverse event rate (missed fractures or unplanned
representations).
Results: A total of 320 patients were enrolled into the study. Of the 236 patients who submitted
completed survey forms, median satisfaction scores were 22 out of 25 with 84% of patients
rating care as ‘‘excellent’’ or ‘‘very good’’. At two week follow up, health status score was
comparable to normal healthy populations. When comparing study groups, patient satisfaction
scores were significantly higher in the ENP group compared to DR group.

∗
Corresponding author. Tel.: +61 02 9515 6111; fax: +61 02 9515 5099.
E-mail addresses: dinh.mm@gmail.com (M. Dinh), walker.andrew@mac.com (A. Walker), ahilan.parameswaran@sswahs.nsw.gov.au
(A. Parameswaran), nenr8314@uni.sydney.edu.au (N. Enright).

1574-6267/$ — see front matter © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.aenj.2012.09.001
Evaluating the quality of care delivered by an emergency department fast track unit
Conclusions: Patients received high quality of care in this fast track unit where both nurse
practitioner and doctors treated patients. Emergency nurse practitioners were associated with
higher patient satisfaction.
© 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights
reserved.
What is known
• Fast track units were established to treat all low
complexity patients presenting to Australian emer-
gency departments.
• Nurse practitioners have been employed previously
to treat such patients in minor injury units.
What this paper adds
• This paper reports on the quality of care delivered
by a fast track unit staffed by both nurse practitioner
and emergency doctors using a validated emergency
satisfaction rating scale and a standard health out-
come survey.
Implications for policy and practice
• Fast track units such as these that manage all low
complexity emergency patients deliver high quality
of care.
• Combining medical and nurse practitioner expertise
may be the optimal model of care in Australian fast
track units.
Larger multicentre trials are needed to evaluate
the overall quality of care delivered by emergency
nurse practitioners working in fast track units.
Introduction
Emergency department fast track units were developed
in Australia to address the needs of the increasing num-
ber of patients presenting to emergency departments with
low complexity problems.1 Fast track units are function-
ally distinct units within emergency departments that allow
patients with low complexity problems to be streamed from
triage and seen separately from more acute problems. This
concept was underlined by a recent Government Inquiry into
acute care at public hospitals in New South Wales Australia
which recommended alternative models of care for emer-
gency department waiting room patients.2 Several studies
have pointed to improved emergency department efficiency
and patient waiting times after implementing fast track
units.1,3—6 Whilst these continue to be the main drivers for
the development of fast track units, it should not be at
the expense of high quality of care for patients presenting
to emergency departments. There are presently no stud-
ies evaluating patient reported outcomes as a measure of
quality of care in fast track units.
Fast track units have also emerged as a potential area
suitable for emergency nurse practitioners.7 Appropriately
189
qualified nursing staff working with existing medical staff
may provide high quality care in this setting. Although there
are several studies comparing nurse practitioners and doc-
tors with respect to patient satisfaction in minor injury
units, none have evaluated quality of care in a dedicated
fast track unit where a range of low complexity prob-
lems are treated (including musculoskeletal, soft tissue
injuries, simple infections and other minor complaints). At
this institution, a single nurse practitioner worked with both
emergency department doctors and a clinical nurse consult-
ant in the emergency fast track unit. The present study was
undertaken to evaluate this model of care.
Aims
The objectives of this study were two-fold. Firstly to
describe the overall quality of care delivered by this fast
track unit and secondly to compare quality of care provided
by a dedicated emergency department nurse practitioner
and emergency doctors in a controlled trial. It was hypothe-
sised that consultation by an emergency nurse practitioner
may be associated with higher levels of patient satisfaction
compared to doctor based care in an emergency department
fast track.
Materials and methods
Study design
This was an observational study using a convenience sample
of emergency patients.
Study setting
The study was conducted in an inner city district level hos-
pital emergency department in an inner west suburb of
Sydney, Australia. The fast track unit within the emergency
department is a functionally distinct unit that sees patients
in dedicated consultation rooms, with a waiting room sepa-
rate from the main ED waiting area. It is staffed by both a
single emergency nurse practitioner and emergency depart-
ment doctors. The emergency nurse practitioner worked
independently, assessing and managing patients within the
fast track unit and was able to consult where appropriate
with senior medical staff in the emergency department.
Emergency department doctors working in the fast track
unit ranged from Resident Medical Officers (post graduate
years 2—4), Emergency Registrars, Career Medical Officers
and Emergency Physicians.
190
Study population
A convenience sample of patients triaged to the fast track
unit was used in this study. Because there was only one nurse
practitioner employed at the time, the study was only under-
taken when nurse practitioners and emergency doctors were
both working on the same shift in fast track.
Inclusion/exclusion criteria
Inclusion criteria
Patients between age 16 and 70 years presenting to the
emergency department and fulfilling fast track criteria were
eligible to be enrolled into this study. Fast track entry crite-
ria included patients who were classified as Australasian
triage scale category four and five who had normal vital signs
and mental state, without complex medical or surgical co-
morbidities who were expecting to be seen and discharged
from the emergency department without the need for mul-
tiple diagnostic tests or specialty consultations.
Exclusion criteria
Patients who were unable to give informed consent, spoke
insufficient English without an available interpreter were
excluded from the study. Patients who had already waited
more than 2 h prior to enrolment were seen by the next
available clinician and were therefore not included in the
study. This was to minimise the disruption to overall emer-
gency department performance and patient flow during busy
periods of patient activity.
Study protocol
Patients enrolled into the study were invited to complete
a patient satisfaction survey instrument at the completion
of fast track consultation. To minimise the effects of con-
founding by intention, consenting patients were randomised
by the triage nurse into two groups — initial assessment
and treatment by an emergency nurse practitioner (ENP)
or initial assessment and treatment by emergency doctor
(DR). Randomisation was achieved using sealed envelope in
a computer generated sequence. Patients randomised to the
DR group were to be seen by the next available emergency
doctor.
The consultation rooms and available equipment were
identical. Patients and clinicians were not blinded to the
study. Emergency nurse practitioners and doctors were free
to consult each other within the fast track unit or with senior
ED medical staff about patient care in accordance to usual
clinical practice, however analysis was by intention to treat.
Study endpoints
The end-point was quality of care measured using both
patient reported outcomes and adverse outcomes. These
consisted of patient satisfaction scores and overall care
rating at the point of discharge, health status at two
week follow up and adverse events (missed fractures and
unplanned representations to any emergency department
within 14 days of initial consultation).
M. Dinh et al.
Patient satisfaction was measured on a self-administered
satisfaction survey instrument completed by the patient
prior to emergency department discharge. Patient satis-
faction was defined by an ‘‘overall care score’’ rating (1,
poor to 5, excellent) as well as total ‘‘satisfaction score’’.
Total satisfaction score was a combined score of 5 elements
(completeness of care, courtesy and politeness, explana-
tion and advice, waiting time, understanding of discharge
instructions) which were all measured on a five point Likert
scale, giving a potential maximum total satisfaction score
of 25. This was validated in a previous study of emergency
department patient satisfaction and quality of care with a
Cronbachs alpha of 0.88.8,9
Patients were asked to complete the survey in private and
submit it in one of two closed boxes located at the entrance
to the ED and fast track waiting rooms.
Follow up health status using Short Form 12 health sur-
vey version two (SF12v2® , QualityMetric Inc. Lincoln Rhode
Island) was performed at two weeks after hospital discharge.
To optimise follow up, three telephone calls within two days
were made to the patient. If no contact was made, the sur-
vey was mailed with a stamped addressed return envelope.
For patients who utilised an interpreter during initial con-
sultation, health services interpreters or a family member
was used to translate.
Adverse outcomes such as unplanned ED representations
to the emergency department (any emergency department
within the Local Health District) within fourteen days of
presentation or missed fractures were compared. These sec-
ondary outcomes were assessed using the electronic patient
tracking system (PowerchartTM Cerner, Kansas City), com-
paring radiology reports to diagnoses on electronic discharge
summaries and by self report at two weeks follow up.
Data analysis and sample size estimation
Descriptive statistics were used to summarise overall quality
of care delivered by this fast track unit. Covariates col-
lected included age, gender, presenting problem, hour of
presentation (business hours defined as 0800—1800), pri-
mary language spoken at home (English vs. other), waiting
time (time from registration to consultation in minutes) and
a General Practitioner nominated by the patient (yes or no).
For study group comparisons, categorical data was com-
pared using Chi squared or Fishers exact test and means
compared using Students t test. Means and medians were
expressed using 95% confidence intervals (95% CIs) and
interquartile range (IQR) respectively. Significance was
defined as p < 0.05.
Physical component summary (PCS) scores and mental
component summary (MCS) scores were computed from
SF12v2® results using aggregated weights and norm based
scoring methods.10
Data was analysed using Stata version 10.1 (College Way,
Texas). A linear regression model was used to adjust total
satisfaction scores for waiting time. Statistical significance
was defined as a two tailed p value < 0.05. Cronbachs alpha
was used as a measure of internal consistency between sur-
vey scales (threshold value of 0.70 satisfying this criterion).
We calculated a sample size based on the proportions of
‘‘excellent’’ for overall care rating between the two groups
Evaluating the quality of care delivered by an emergency department fast track unit
found in an unpublished pilot study conducted at the same
institution. A difference of 60% vs. 40% in ‘‘excellent’’ rat-
ings found in the pilot study requires a sample size of 107
in each treatment group to obtain a power of 0.80 assum-
ing a two-tailed alpha value of 0.05. We assumed a loss to
follow up of 10%. Sample size estimations were also calcu-
lated for an error margin of 5% each side of the percentage
estimate obtained with the satisfaction survey with a con-
fidence level of 95%. Estimating a total population pool of
around 800 patients, a total of 260 would be required.
Ethics
Ethics approval was sought and granted by the Sydney South
West Area Health Service Ethics Review Committee (RPAH
Zone), protocol X09-0285 and HREC/09/RPAH/481. The trial
was registered with the Australian and New Zealand Clinical
Trials Registry ACTRN 12609000930280.
Results
Study interval
Patient enrolment commenced April 2010 and completed in
April 2011.
Study population
Over 90 days during the study interval 800 eligible patients
were identified. Of these 320 patients consented and
enrolled into the study — 155 were seen initially by emer-
gency department doctors (DRs) and 165 by the emergency
nurse practitioner (ENP). Of the DR group, 40 were seen by
Emergency Medicine Trainees (Registrars), 42 by junior med-
ical officers (post graduate year 1—3), 9 by Career Medical
Officers and 12 patients were seen by Emergency Consul-
tants.
Median patient age was 36 years (IQR 25—46 years).
Sixty one percent were male (146/236) and 72% (230/320)
were treated for musculoskeletal problems. English was
the primary language in 66% (211/320) of patients and 78%
(249/320) could identify a regular family doctor. The median
waiting time to be seen by either doctor or nurse practi-
tioner was 53 min (IQR 33—87) and overall 64% of patients
were seen within current Australasian triage scale wait-
ing time benchmarks (60 min for triage category four and
120 min for triage category five). Nine percent of patients
were admitted to the hospital as inpatients from the fast
track unit.
Overall quality of care
Satisfaction surveys were completed in 74% (236/320) of
patients. The median satisfaction score was 22 out of 25
(IQR 19—24) (see Fig. 1). With respect to overall care rat-
ing, 84% of patients rated overall care as either ‘‘very good’’
or ‘‘excellent’’, 13% indicated ‘‘good’’ and only 3% rated
their care as ‘‘fair’’. No patients rated care as ‘‘poor’’ (see
Fig. 2).
191
Distribution of patient satisfaction scores*
n=236
80
60
Frequency
40
20
0
5 10 15 20 25
Satisfaction score
*Higher scores denote greater patient satisfaction (maxium 25 points)
Figure 1 Fast track patient satisfaction score distribution.
Figure 2 Distribution of overall care ratings between study
groups.
At two week follow up 75% of patients (176/236) were
able to be contacted. Using SF12v2, mean and standard devi-
ations of PCS scores were 47.8 ± 8.7 (95% CI 49.5—49.1) and
MCS scores were 51.5 ± 9.5 (95% CI 50.1—53.0) respectively.
Internal consistency for all 12 items of SF12v2 was good with
Crohnbachs alpha of 0.82.
Unplanned representations or missed fractures occurred
in 8% (18/236) of patients. Most of these were of minor
clinical significance (small avulsion fractures of the ankle,
plaster problems or unscheduled wound reviews), none
required additional intervention or referrals and there were
no patient complaints.
Comparing quality of care between study groups
When comparing study groups, 66% of patients (103/155)
in the DR group and (81%) 133/165 in the ENP group com-
pleted satisfaction forms. At follow-up, 32 patients in the
DR group who completed survey forms and 28 patients in
the ENP group were uncontactable or declined to be inter-
viewed. Follow up rates were therefore 71% (71/103) in the
DR group and 79% (105/133) in the ENP group.
A comparison of baseline demographic and presenting
characteristics between study groups is shown in Table 1.
192 M. Dinh et al.

Table 1 Comparing baseline characteristics between study groups.

Demographics DR (n = 103) 95% CI or IQR ENP (n = 133) 95% CI or IQR p values

Age (median, years) 33 24—48 37 25—47 0.40

Male (%) 66 (64) (55—73) 80 (60) (52—69) 0.54
Waiting time to be seen (median, mins) 57 31—110 50 33—77 0.06
Business hours presentation (%) 50 (49) 39—58 52 (39) 31—47 0.15
Musculoskeletal presenting problem (%) 73 (71) 62—80 97 (73) 65—81 0.73
In patient admission (%) 7 (7) 2—12 14 (11) 5—16 0.36a
Full-time employment (%) 62 (60) 53—74 77 (58) 50—67 0.22
English as primary language (%) 68 (66) 62—83 90 (67) 61—78 0.65
Patient has regular family doctor 81 (79) 72—91 97 (73) 66—83 0.21
a Fisher’s exact test.

There was a trend to shorter waiting time in the ENP group
with a difference of 7 min (p = 0.06). All other baseline char-
acteristics are similar.
There is evidence to suggest that overall care rating cat-
egories were significantly different between study groups
with a higher proportion of patients in the ENP group rat-
ing their care as excellent compared to DR group (68% vs.
50% Fishers exact p = 0.02) (see Fig. 2). Total satisfaction
scores were significantly higher in the ENP group compared
to DR group (median scores 23, IQR 20—24 vs. 21 (16—24)
p = 0.002). Cronbachs alpha for five items of patient satis-
faction 0.80 Total satisfaction score was adjusted for waiting
time. Higher patient satisfaction in the ENP group remained
statistically significant, with a mean total satisfaction score
1.5 points higher in the ENP group for a given waiting time
(beta coefficient = 1.5 p = 0.004, 95% CI 0.48—2.5).
Responses to the general health component of SF-12aTM
at two week follow up were compared using Fisher’s exact
test. ‘‘Excellent’’ health was reported by 13% in the DR
group and 31% in the ENP group (p = 0.015) (see Fig. 3). No
significant difference was found in both PCS scores (mean
scores DR vs. ENP 48.0 vs. 47.6 p = 0.78) and MCS scores
(51.2 vs. 51.7 p = 0.58) between study groups at two week
telephone follow up.
Unplanned representations and missed fractures
occurred in 5 (6%) of DR group and 12 (9%) of ENP group
(p = 0.22). There were only two missed fractures, one in
each group, neither of which was clinically significant.
Figure 3 General health status (Q1 of SF12v2) at two weeks
follow-up.
Discussion
This was a quality of care evaluation study of patients seen in
an emergency department fast track unit. The results of the
present study suggest that a fast track unit comprising both
nurse practitioners working together with doctors and other
senior nurses provides high quality of care. This was demon-
strated by high satisfaction scores (median score 22 out of
25), high overall care rating (86% rated care as very good or
excellent) and follow up health status scores at two weeks
which were consistent with scores obtained from a normal
healthy population.11 Although loss to follow up rates were
relatively high in this study, there is evidence to suggest that
patients initially treated by emergency nurse practitioners
may be associated with higher levels of patient satisfaction
with no apparent difference in rates of adverse events or
health status at two weeks follow up.
To our knowledge this is the first study to systematically
evaluate quality of care using patient reported outcomes in
an emergency fast track or similar setting. Unlike previous
studies evaluating emergency nurse practitioner perfor-
mance in minor injury units, the present study evaluated
care in a unit that treats a variety of minor complaints.
No other controlled trials to date have evaluated follow up
health status with validated health status instruments in the
fast track setting.
Patient satisfaction in this fast track unit compare
favourably with previous emergency department studies
using this satisfaction instrument.8,9 In these studies only
60% of general emergency department patients rated care as
either ‘‘excellent’’ or ‘‘very good’’, and mean overall care
rating scores out of 5 were 3.8 (95% CI 3.7—3.8) compared to
mean satisfaction score observed in the present study of 4.4
(95% CI 4.3—4.5). The findings also compare favourably with
local data on emergency department patient satisfaction.
An ongoing population health survey in New South Wales
found that 60% of those who had visited any emergency
department within the previous 12 months rated their over-
all care as excellent or very good.12 Comparisons with other
trials involving nurse practitioner performance are difficult
due to the range of satisfaction survey instruments used. The
rate of adverse outcomes in the present study was around 8%
which appears high. A large randomised control trial eval-
uating quality of care in an emergency department minor
Evaluating the quality of care delivered by an emergency department fast track unit
injuries unit published in Lancet in 1999 found that clini-
cally important errors were made in 9.2% of patients seen by
emergency nurse practitioners compared to 10.7% of junior
doctors.13
With respect to study group comparisons, our findings
are broadly consistent with published trials of nurse prac-
titioner based care evaluating patient satisfaction.14—17 A
randomised trial conducted in the UK suggested greater
satisfaction in a convenience sample of 199 patients pre-
senting to a minor injuries unit.18 There was no difference
in outcomes such as time of recovery and days off work in
that study. However a similar trial involving 169 patients
presenting with minor injuries and wound management in
rural Australia did not demonstrate a difference in patient
satisfaction.18 It is unclear how a two point difference in
patient reported satisfaction scores observed in this trial
translates to differences in clinical outcome. Studies have
suggested increasing patient satisfaction are associated with
improved compliance with treatment and follow up.8 This
does not appear to be demonstrated in this study as follow
up health status appears to be similar in both study groups.
Despite the evidence, most trials evaluating emergency
nurse practitioners to date have evaluated their role only in
minor injury units. Therefore the role of emergency nurse
practitioners should be seen as complementary to, not a
substitute for, existing medical staff. Trials that compare
nurse practitioners with junior medical officers12,14,15 remain
problematic because of this, as the objectives and scope of
the two roles are fundamentally different. Junior medical
officers are expected to assess and manage a wide variety
of clinical problems in the emergency department with the
concurrent aim of developing experience and training in all
areas of acute medicine and surgery. Consultations rates and
competing priorities from more acute and complex patients
being simultaneously managed by medical and nursing staff
are difficult to measure and compare. Senior clinicians such
as nurse practitioners with particular expertise in areas such
as minor injury should work collaboratively with doctors,
as in the present study, to enable more efficient streaming
of low complexity presentations within emergency depart-
ments. It was within this context that the present study was
conducted.
The present study has several important limitations that
potentially affect the validity of results. The trial was based
on a convenience sample with only 75% of patients com-
pleting the initial evaluation. This may have introduced
selection bias resulting in higher than expected patient sat-
isfaction. Loss to follow up at telephone contact is consistent
with previous studies using telephone follow up.9,13 The
survey instrument was completed by patients in an unsu-
pervised setting and many submitted incomplete forms with
missing fields or blank forms. This appeared to be a par-
ticular problem with the DR group where more patients
appeared to leave the emergency department prior to con-
sultation. This resulted in significant selection bias when
comparing doctor and emergency nurse practitioner per-
formance. It is difficult to speculate how the bias would
affect results. Empirically it would be plausible to assume
that patients who left without being seen or who did not
fill in satisfaction surveys were less satisfied than those who
did. If this were the case, the observed difference would be
amplified. The patient satisfaction survey instrument used
193
in this study8,9 has been previously validated in the U.S.
emergency department setting but has not previously been
used in the Australian context. It is however the only instru-
ment in the emergency literature that the authors are aware
of that has formally been derived and evaluated for inter-
nal consistency. It is not known how frequently that senior
medical consultation or subspecialty referrals were made
by either ENP or DR groups and this may influence quality of
care provided. The ENP was required to consult with senior
ED medical staff whenever clinically appropriate, but this
was not the case for the DR group.
The other important limitation was that this fast track
unit only employs one nurse practitioner who had over seven
years clinical experience. It remains to be seen whether the
results of this study are externally valid and comparable to
similarly experienced medical staff. It would be interesting
to compare quality of care in a cluster randomised trial of
units where nurse practitioners were either working in fast
track units or not.
In conclusion, the present study demonstrated that
high quality of care was delivered in a setting where
an experienced nurse practitioner worked with emergency
department doctors. Although patient satisfaction appeared
to be slightly higher in the nurse practitioner group, over-
all health outcomes and adverse event rates were similar at
two week follow up.
Authorship statement
Michael Dinh involved in study design, literature review data
analysis and manuscript preparation. Andrew Walker showed
his involvement in study design, literature review, data
collection, manuscript preparation. Ahilan Parameswaran
contributed in data collection, manuscript review. Nicholas
Enright involved in data collection, literature review,
manuscript preparation.
Funding
No external funding was sought or obtained for this study.
Provenance and conflict of interest
No conflicts of interest declared. This paper was not com-
missioned.
Acknowledgements
We would like to acknowledge and thank Dr. Matthew Chu
and the medical and nursing staff of the Canterbury Hospital
Emergency Department for their support of the study.
References
1. Ieraci S, Diguisto E, Sonntag P, Dann L, Fox D. Evaluation of a
model for emergency department fast track. Emerg Med Austral
2008;20:241—9.
2. Garling P. Final report of the special commission of inquiry.
Acute Care Services in NSW Public Hospitals; November 2008.
194
3. Rodi SW, Grau MV, Orsini CM. Evaluation of a fast track unit:
alignment of resources and demand results in improved satis-
faction and decreased length of stay for emergency department
patients. Qual Manage Health Care 2006;15:163—70.
4. Hutchison B. The place of walk-in clinics in healthcare systems.
BMJ 2000;321:909—10.
5. Jones M. Walk-in primary medical care centres: lessons from
Canada. BMJ 2000;321:928—31.
6. Cooke MW, Wislon S, Pearson S. The effect of a separate stream
for minor injuries on accident and emergency department wait-
ing times. Emerg Med J 2002;19:28—30.
7. Carter AJ, Chochinov AH. A systematic review of the impact of
emergency nurse practitioners on cost, quality of care, satisfac-
tion and wait times in the emergency department. Can J Emerg
Med 2007;9:286—95.
8. Sun BC, Adams JG, Burstin HR. Validating a model of
patient satisfaction with emergency care. Ann Emerg Med
2001;38:527—32.
9. Burstin HR, Conn A, Setnik G, Rucker DW, Cleary PR, ONiell
AC, et al. Benchmarking and quality improvement. The
Harvard emergency department quality study. Am J Med
1999;107:437—49.
10. Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. Users manual
for the SF12v2® health survey. 2002 Quality Metric Inc., Lincoln,
Rhode Island. ISBN 1-891810-10-3.
11. Avery J, Dal Grande E, Taylor A. Quality of life as measured
in South Australia by the SF12 health status questionnaire.
M. Dinh et al.
Population norms for 2003. South Australian Department of
Human Services 2004. Adelaide. ISBN 0 7308 9329 4.
12. Centre for Epidemiology and Research. 2009 summary report
on adult health from the New South Wales population health
survey. Sydney. NSW Department of Health; 2010.
13. Sakr M, Angus J, Perrin J, Nixon C, Nicholl J, Wardrope J.
Care of minor injuries by emergency nurse practitioners or
junior doctors: a randomised controlled trial. Lancet 1999;354:
1321—6.
14. Byrne G, Richardson M, Brunsdon J, Patel A. Patient satisfac-
tion with emergency nurse practitioners in A&E. J Clin Nurs
2000;9:83—92.
15. Considine J, Martin R, DeVilliers S, Winter C, Jenkins J.
Emergency nurse practitioner care and emergency depart-
ment patient flow: case—control study. Emerg Med Austral
2006;18:385—90.
16. Jennings N, O’Reilly G, Lee G, Cameron P, Free B, Bailey M.
Evaluating Outcomes of the emergency nurse practitioner role
in a major urban emergency department, Melbourne, Australia.
J Clin Nurs 2008;17:1044—50.
17. Rhee KJ, Dermyer AL. Patient satisfaction with an emergency
nurse practitioner in a university emergency service. Ann Emerg
Med 1995;26:130—2.
18. Cooper MA, Lindsay GM, Kinn S, Swann IJ. Evaluating emergency
nurse practitioner services: a randomised controlled trial. J Adv
Nurs 2002;40:721—30.