• Antonette Silvestri, Noreen McDaniel-Yakscoe, Kate O'Neill, Darlene Bradley, Harriet Hawkins, Reneé Holleran, Pam Burke, Susan Hohenhaus, and Patricia Kunz Howard.
• The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. Silvestri@email.chop.edu
• Pediatr Emerg Care. 2005 Mar 1; 21 (3): 199-202.

BackgroundThe use of observational units (OUs) in pediatric emergency departments (EDs) has become an important adjunct to emergency care. An extended observation period (4 to 23 hours) in the ED has decreased both the number of admissions and prolonged use of acute ED beds. This serves to increase patient satisfaction as well as optimizing care. The use of OUs allows for the most appropriate allocation of resources. These units are typically located within the ED or immediately adjacent to it. The ED physicians are the gatekeepers of the unit and serve as the medical supervision for these patients. The Children's Hospital of Philadelphia developed an OU known in the hospital as the Emergency Department Extended Care Unit (EDECU) approximately 5 years ago. In order for the EDECU to function at its fullest potential, the ED at The Children's Hospital of Philadelphia has opted to use the ED nurse practitioners (NPs) to enhance the care for these patients.ObjectiveThe NP has been an integral member of the ED for the past 10 years with primary roles in urgent care and in the follow-up program. As the ED expanded to include the EDECU, the role of the NP also developed to meet the needs of these patients. A review of the role development of the ED NP in observation medicine and the impact on patient and staff satisfaction as well as contributing to fiscally responsible care will be addressed.MethodsA retrospective review of the NP's role development in the evolution of the EDEDU.ResultsIncorporation of the NP in the treatment team has provided efficient use of professional staff, comprehensive patient care, and increased patient satisfaction.ConclusionsThe use of the EDECU has become an important part of the services offered in the ED at The Children's Hospital of Philadelphia. The integration of the NP in a pivotal role allows for optimal use of human resources, and provides efficient, cost-effective patient care in the ED.

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