Maltese nurses’ and doctors’ perception of hip fast track in an emergency setting

Abstract

Background: Escalating congestions in emergency departments have been observed mainly due to the observed population expansion which have placed increasingly daily challenges stretching medical staff and resources. This resulted in hip-fracture patients to suffer prolonged waiting times. A response to the above as a potential solution has been the possibility of expanding the traditional role of Nurses, through utilising nurse-led pathways. In this study the Adult Hip Fracture Pathway has been explored as one of the recommendations. Objectives: This study aims to explore the perspectives of emergency nurses and physicians on nurse-led pathways and the expansion of nursing roles in the Maltese ED through the Pragmatic Philosophical Paradigm. The researcher seeks to uncover insights into their attitudes, experiences, and suggestions for optimising nurse-led pathways, with the goal of enhancing patient outcomes and healthcare delivery in relation to reducing experienced pain and increasing patient satisfaction rates. Design and Methods: The study used a mixed-method approach, including both quantitative questionnaires and qualitative one-to-one interviews. Utilising probability sampling techniques, sixty-three nurses and doctors working in the local emergency department participated in the self-administered online questionnaire which was then content analysed. Eight participants, four nurses and four doctors, took part in the self-developed interview with the researcher, which was thematically analysed. Results: The overall perception of the hip fast-track was positive, with nurses and doctors perceiving better patient satisfaction and observed pain relief. Both nurses and doctors expressed confidence in more experienced nurses booking these investigations. Another topic discussed was the possible introduction of further fast-track pathways. This was perceived as positive and encouraging, with fast-track pathways for renal colic and urine retention being among the most frequently mentioned. Conclusions: The possible implementation of the hip fast-track system promises to significantly improve patient care and streamline processes within our healthcare facility. However, there was a minority of doctors who believed that nurses should not take on the additional role. The incorporation of regular training and enabling nurses to book investigations may improve patient and staff morale, reflecting positively on the current hip fast-track system's perceived lack of innovation.