1College of Nursing, Seoul National University, Seoul
2Department of Nursing, Namseoul National University, Cheonan
3Department of Nursing, Sangmyung University, Cheonan, Korea
© 2013 Korean Society of Adult Nursing
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Advanced practice | Relative Value Scale | Time | (RVS∗T) | Frequency (1 person/yr) | |||
---|---|---|---|---|---|---|---|
Technical skill | Mental effort | Stress | Mean | ||||
ABGA with POCT | 100.0 | 100.0 | 100.0 | 100.0 | 7:03 | 703.0 | 1,584 |
Sampling in Blood culture | 130.7 | 119.8 | 138.1 | 129.5 | 13:51 | 1,750.0 | 528 |
Sampling and irrigation from tube | 100.4 | 90.2 | 98.1 | 96.2 | 5:25 | 505.2 | 48 |
Electrocardiogram | 82.3 | 85 | 82.7 | 96.2 | 4:13 | 344.2 | 2,640 |
Simple dressing | 76.2 | 72.4 | 71.6 | 73.4 | 7:02 | 515.3 | 112.8 |
Bed sore dressing | 130.5 | 132.8 | 131.6 | 131.6 | 9:39† | 1,236.0 | 51.6 |
Cervical immobilization | 91.3 | 97.4 | 93.2 | 94.0 | 5:00† | 469.8 | 24 |
Spinal board immobilization | 93.3 | 93.0 | 86.4 | 90.9 | 10:15† | 922.6 | 5 |
Emergency patient. transfer | 159.0 | 170.0 | 156.0 | 161.7 | 9:30 | 1,503.5 | 7 |
Defibrillation | 160.1 | 205.9 | 207.9 | 191.3 | 2:30† | 440.0 | 2 |
CPR | 322.9 | 274.4 | 291.7 | 296.3 | 11:50† | 3,407.8 | 64.8 |
Bag valve mask ventilation | 174.8 | 189.1 | 195.7 | 186.5 | 13:12† | 2447.3 | 36 |
NIV care | 172.4 | 182.1 | 189.3 | 181.3 | 5:50 | 997.0 | 18 |
Care of patient with ventilator | 236.3 | 243.3 | 242.3 | 240.6 | 11:11 | 2,673.4 | 55 |
Chemoport needle insertion | 111.1 | 210.7 | 115.9 | 145.9 | 19:16 | 2,795.4 | 12 |
Arterial catheter insertion | 157.2 | 168.6 | 163.3 | 163.0 | 15:00 | 2,445.5 | 42 |
Intravenous catheter insertion | 110.1 | 79.8 | 99.9 | 96.6 | 7:29 | 704.2 | 396 |
Nasogastric tube insertion | 106.2 | 97.8 | 106.2 | 103.4 | 9:47† | 979.2 | 6 |
Gastric lavage (GI bleeding) | 137.1 | 97.2 | 112.2 | 115.5 | 24:43 | 2,821.7 | 5 |
Transcutaneous pacing | 150.1 | 175.2 | 187.9 | 171.1 | 12:33 | 2,109.3 | 8 |
Chest bottle change | 112.7 | 106.7 | 111.6 | 110.3 | 6:06 | 668.6 | 7 |
Retention enema | 140.0 | 115.9 | 160.2 | 138.7 | 9:43† | 1,307.9 | 1 |
Supervised medication of emergency drug | 162.3 | 195.1 | 198.2 | 185.2 | 4:04 | 748.2 | 240 |
Hemodynamic monitoring | 143.7 | 160.4 | 151.6 | 151.9 | 10:00 | 1,519.0 | 84 |
Triage | 153.1 | 203.8 | 208.1 | 188.3 | 3:56 | 670.5 | 1,533 |
Mean | 140.6 | 146.7 | 147.9 | 145.1 | 9:40 | 1,774.9 | 300.4 |
Proportion of indirect cost in ENP'S total cost | |||||||
Conversion factor | 0% | 10% | 20% | 30% | |||
12.21 | 13.43 | 14.65 | 15.90 |
Advanced practice | Health insurance | Health insurance RVS | Adjusted RVS of ENP | |||
---|---|---|---|---|---|---|
0% (CR) | 10% (CR) | ) 20% (CR) | 30% (CR) | |||
ABGA with POCT | Blood gas study | 134.54 | 18.48 | 20.30 | 22.12 | 24.09 |
(13.74) | (15.09) | (16.44) | (17.91) | |||
Sampling in blood culture | Microorganism culture, identification and antibiotics sensitivity test | 207.06 | 46.01 | 50.54 | 55.07 | 59.97 |
(22.22) | (24.41) | (26.59) | (28.96) | |||
Sampling and irrigation from tube | Natural drainage and care after operation (per day) | 113.96 | 13.28 | 14.59 | 15.90 | 17.31 |
(11.66) | (12.80) | (13.95) | (15.19) | |||
Electrocardiogram | EKG tracing and interpretation | 68.85 | 9.05 | 9.94 | 10.83 | 11.79 |
(13.14) | (14.44) | (15.73) | (17.13) | |||
Simple dressing | Simple dressing | 58.04 | 13.55 | 14.88 | 16.21 | 17.66 |
(23.34) | (25.64) | (27.94) | (30.42) | |||
Bed sore dressing | Infectious wound dressing (per day) | 112.10 | 32.50 | 35.70 | 38.89 | 42.36 |
(28.99) | (31.84) | (34.70) | (37.79) | |||
Cervical immobilization | Cervical immobilization with cervical collar, etc. | 209.37† | 12.35 | 13.57 | 14.78 | 16.10 |
(5.90) | (6.48) | (7.06) | (7.69) | |||
Spinal board immobilization | Spine immobilization | 689.76† | 24.26 | 26.65 | 29.03 | 31.62 |
(3.52) | (3.86) | (4.21) | (4.58) | |||
Emergency patient. transfer | - | - | 39.53 | 43.42 | 47.31 | 51.52 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Defibrillation | Defibrillation, cardioversion (per day) | 1,213.53† | 34.71 | 38.12 | 41.54 | 45.23 |
(2.86) | (3.14) | (3.42) | (3.73) | |||
Cardiopulmonary resuscitation | Cardiopulmonary resuscitation (15min) | 1,204.32† | 268.75 | 295.19 | 321.62 | 350.26 |
(22.32) | (24.51) | (26.71) | (29.08) | |||
Bag valve mask ventilation | Mechanical ventilation: within 3hr | 512.82† | 64.35 | 70.68 | 77.01 | 83.87 |
(12.55) | (13.78) | (15.02) | (16.35) | |||
Non-invasive ventilation care | BIPAP treatment (per day) | 1,202.65 | 78.65 | 86.38 | 94.12 | 102.50 |
(6.54) | (7.18) | (7.83) | (8.52) | |||
Care of pt with ventilator | Mechanical ventilation: within 3hr | 830.15† | 70.30 | 77.21 | 84.12 | 91.62 |
(8.47) | (9.30) | (10.13) | (11.04) | |||
Chemoport needle insertion | - | - | 73.50 | 80.73 | 87.96 | 95.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Arterial catheter insertion | - | - | 64.30 | 70.63 | 76.95 | 83.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Intravenous catheter insertion | - | - | 18.52 | 20.34 | 22.16 | 24.13 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Nasogastric tube insertion | Nasogastric tube insertion | 168.09 | 25.75 | 28.28 | 30.81 | 33.56 |
(15.24) | (16.74) | (18.24) | (19.86) | |||
Gastric lavage | Gastric lavage: GI bleeding | 539.70† | 74.19 | 81.49 | 88.791 | 96.69 |
(13.75) | (15.10) | (16.45) | (17.52) | |||
Transcutaneous pacing | Transcutaneous cardiac pacing | 119.14 | 55.46 | 60.92 | 66.37 | 72.28 |
(46.55) | (51.13) | (55.71) | (60.67) | |||
Chest bottle change | Natural drainage and care after operation (per day) | 47.57 | 17.58 | 19.31 | 21.04 | 22.91 |
(36.96) | (40.59) | (44.23) | (48.17) | |||
Retention enema | Retention enema | 89.50 | 34.39 | 37.77 | 41.16 | 44.82 |
(38.43) | (42.21) | (45.99) | (50.08) | |||
Supervised medication of emergency drug | - | - | 19.67 | 21.61 | 23.54 | 25.64 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Hemodynamic monitoring | - | - | 39.94 | 43.87 | 47.80 | 52.05 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Triage | - | - | 17.63 | 19.36 | 21.10 | 22.98 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Mean | 46.67 | 51.26 | 55.85 | 60.82 | ||
(13.05) | (14.33) | (15.61) | (17.00) |
General Characteristics (N=30)
Characteristics | Categories | n (%) | M±SD | Min | Max |
---|---|---|---|---|---|
Gender | Male | 2 (6.7) | |||
Female | 28 (93.3) | ||||
Age (year) | <30 | 9 (30.0) | 33.73±4.40 | 27 | 42 |
30~39 | 18 (60.0) | ||||
≥40 | 3 (10.0) | ||||
Marital status | Single | 12 (40.0) | |||
Married | 18 (60.0) | ||||
Clinical career (year) | ≤10 | 12 (40.0) | 11.37±4.39 | 5 | 19 |
11~15 | 10 (33.3) | ||||
≥16 | 8 (26.7) | ||||
Clinical career in ED (year) | <3 | 18 (60.0) | 6.44±4.21 | 1.7 | 8.0 |
3~5 | 8 (26.7) | ||||
>5 | 4 (13.3) |
ED=emergency department.
Relative Value Scale, Time, Frequency in Emergency Nurse Practitioner
Advanced practice | Relative Value Scale | Time | (RVS∗T) | Frequency (1 person/yr) | |||
---|---|---|---|---|---|---|---|
Technical skill | Mental effort | Stress | Mean | ||||
ABGA with POCT | 100.0 | 100.0 | 100.0 | 100.0 | 7:03 | 703.0 | 1,584 |
Sampling in Blood culture | 130.7 | 119.8 | 138.1 | 129.5 | 13:51 | 1,750.0 | 528 |
Sampling and irrigation from tube | 100.4 | 90.2 | 98.1 | 96.2 | 5:25 | 505.2 | 48 |
Electrocardiogram | 82.3 | 85 | 82.7 | 96.2 | 4:13 | 344.2 | 2,640 |
Simple dressing | 76.2 | 72.4 | 71.6 | 73.4 | 7:02 | 515.3 | 112.8 |
Bed sore dressing | 130.5 | 132.8 | 131.6 | 131.6 | 9:39 |
1,236.0 | 51.6 |
Cervical immobilization | 91.3 | 97.4 | 93.2 | 94.0 | 5:00 |
469.8 | 24 |
Spinal board immobilization | 93.3 | 93.0 | 86.4 | 90.9 | 10:15 |
922.6 | 5 |
Emergency patient. transfer | 159.0 | 170.0 | 156.0 | 161.7 | 9:30 | 1,503.5 | 7 |
Defibrillation | 160.1 | 205.9 | 207.9 | 191.3 | 2:30 |
440.0 | 2 |
CPR | 322.9 | 274.4 | 291.7 | 296.3 | 11:50 |
3,407.8 | 64.8 |
Bag valve mask ventilation | 174.8 | 189.1 | 195.7 | 186.5 | 13:12 |
2447.3 | 36 |
NIV care | 172.4 | 182.1 | 189.3 | 181.3 | 5:50 | 997.0 | 18 |
Care of patient with ventilator | 236.3 | 243.3 | 242.3 | 240.6 | 11:11 | 2,673.4 | 55 |
Chemoport needle insertion | 111.1 | 210.7 | 115.9 | 145.9 | 19:16 | 2,795.4 | 12 |
Arterial catheter insertion | 157.2 | 168.6 | 163.3 | 163.0 | 15:00 | 2,445.5 | 42 |
Intravenous catheter insertion | 110.1 | 79.8 | 99.9 | 96.6 | 7:29 | 704.2 | 396 |
Nasogastric tube insertion | 106.2 | 97.8 | 106.2 | 103.4 | 9:47 |
979.2 | 6 |
Gastric lavage (GI bleeding) | 137.1 | 97.2 | 112.2 | 115.5 | 24:43 | 2,821.7 | 5 |
Transcutaneous pacing | 150.1 | 175.2 | 187.9 | 171.1 | 12:33 | 2,109.3 | 8 |
Chest bottle change | 112.7 | 106.7 | 111.6 | 110.3 | 6:06 | 668.6 | 7 |
Retention enema | 140.0 | 115.9 | 160.2 | 138.7 | 9:43 |
1,307.9 | 1 |
Supervised medication of emergency drug | 162.3 | 195.1 | 198.2 | 185.2 | 4:04 | 748.2 | 240 |
Hemodynamic monitoring | 143.7 | 160.4 | 151.6 | 151.9 | 10:00 | 1,519.0 | 84 |
Triage | 153.1 | 203.8 | 208.1 | 188.3 | 3:56 | 670.5 | 1,533 |
Mean | 140.6 | 146.7 | 147.9 | 145.1 | 9:40 | 1,774.9 | 300.4 |
Proportion of indirect cost in ENP'S total cost | |||||||
Conversion factor | 0% | 10% | 20% | 30% | |||
12.21 | 13.43 | 14.65 | 15.90 |
ENP=emergency nurse practitioner; ABGA=arterial blood gas analysis. POCT=point of care test; CPR=cardio-pulmonary resuscitation, NIV=non-invasive ventilation. GI=gastric intestine.
†Reporting data in Kim et al. (2010).
Costs of Advanced Nursing Practice in Emergency Nurse Practitioner
Advanced practice | Health insurance | Health insurance fee | Cost by indirect cost rate | |||
---|---|---|---|---|---|---|
0% | 10% | 20% | 30% | |||
ABGA with POCT | Blood gas study | 11,545 | 1,586 | 1,742 | 1,898 | 2,067 |
Sampling in blood culture | Microorganism culture identification and antibiotics sensitivity test | 1,7766 | 3,948 | 4,336 | 4,724 | 5,145 |
Sampling and irrigation from tube | Natural drainage and care after operation (per day) | 9,778 | 1,140 | 1,252 | 1,364 | 1,486 |
Electrocardiogram | EKG tracing and interpretation | 5,907 | 778 | 852 | 929 | 1,011 |
Simple dressing | Simple dressing | 4,908 | 1,162 | 1,276 | 1,391 | 1,51 |
Bed sore dressing | Infectious wound dressing (per day) | 9,618 | 2,788 | 3063 | 3,337 | 3,634 |
Cervical immobilization | Cervical immobilization with cervical collar, etc. | 11,976 | 1,060 | 1,164 | 1,268 | 1,381 |
Spinal board immobilization | Spine immobilization | 39,454 | 2,081 | 2.286 | 2,491 | 2,713 |
Emergency patient. transfer | Involved admission care | 25,000 | 3,392 | 3,725 | 4,059 | 4,421 |
Defibrillation∗ | Defibrillation, cardioversion (per day) | 69,414 | 2,978 | 3,270 | 3,564 | 3,881 |
CPR | Cardiopulmonary resuscitation (15min) | 68,887 | 23,059 | 25,327 | 27,595 | 30,052 |
Bag valve mask ventilation | Mechanical ventilation : within 3hr | 29,333 | 5,521 | 6,064 | 6,607 | 7,196 |
NIV care | BIPAP treatment (per day) | 103,187 | 6,748 | 7,411 | 8,075 | 8,794 |
Care of patient with ventilator | Mechanical ventilation: within 3hr | 47,484 | 6,031 | 6,624 | 7,218 | 7,861 |
Chemoport needle insertion | - | 6,307 | 6,927 | 7,547 | 8,219 | |
Arterial catheter insertion | - | 5,517 | 6,059 | 6,602 | 7,190 | |
Intravenous catheter insertion | - | 1,588 | 1,745 | 1,901 | 2,071 | |
Nasogastric tube insertion | Nasogastric tube insertion | 14,494 | 2,209 | 2,426 | 2,644 | 2,879 |
Gastric lavage | Gastric lavage: GI bleeding | 30,873 | 6,366 | 6.992 | 7,618 | 8,296 |
Transcutaneous pacing | Transcutaneous cardiac pacing | 10,222 | 4,759 | 5,227 | 5,694 | 6,202 |
Chest bottle change | Natural drainage and care after operation (per day) | 4,081 | 1,508 | 1,657 | 1,805 | 1,966 |
Retention enema | Retention enema | 7,679 | 2,951 | 3,241 | 3,531 | 3,846 |
Supervised medication of emergency drug | Involved admission care | 1,688 | 1,854 | 2,020 | 2,200 | |
Hemodynamic monitoring | - | 3,430 | 3,764 | 4,101 | 4,466 | |
Triage | Involved admission care | 1,513 | 1,661 | 1,810 | 1,971 |
EKG=electrokardiogram; BIPAP=Bi-level positive airway pressure.
†Multiply one defibrillation by three.
Contribution Rate of Advanced Nursing Practice in Relative Value Scale
Advanced practice | Health insurance | Health insurance RVS | Adjusted RVS of ENP | |||
---|---|---|---|---|---|---|
0% (CR) | 10% (CR) | ) 20% (CR) | 30% (CR) | |||
ABGA with POCT | Blood gas study | 134.54 | 18.48 | 20.30 | 22.12 | 24.09 |
(13.74) | (15.09) | (16.44) | (17.91) | |||
Sampling in blood culture | Microorganism culture, identification and antibiotics sensitivity test | 207.06 | 46.01 | 50.54 | 55.07 | 59.97 |
(22.22) | (24.41) | (26.59) | (28.96) | |||
Sampling and irrigation from tube | Natural drainage and care after operation (per day) | 113.96 | 13.28 | 14.59 | 15.90 | 17.31 |
(11.66) | (12.80) | (13.95) | (15.19) | |||
Electrocardiogram | EKG tracing and interpretation | 68.85 | 9.05 | 9.94 | 10.83 | 11.79 |
(13.14) | (14.44) | (15.73) | (17.13) | |||
Simple dressing | Simple dressing | 58.04 | 13.55 | 14.88 | 16.21 | 17.66 |
(23.34) | (25.64) | (27.94) | (30.42) | |||
Bed sore dressing | Infectious wound dressing (per day) | 112.10 | 32.50 | 35.70 | 38.89 | 42.36 |
(28.99) | (31.84) | (34.70) | (37.79) | |||
Cervical immobilization | Cervical immobilization with cervical collar, etc. | 209.37 |
12.35 | 13.57 | 14.78 | 16.10 |
(5.90) | (6.48) | (7.06) | (7.69) | |||
Spinal board immobilization | Spine immobilization | 689.76 |
24.26 | 26.65 | 29.03 | 31.62 |
(3.52) | (3.86) | (4.21) | (4.58) | |||
Emergency patient. transfer | - | - | 39.53 | 43.42 | 47.31 | 51.52 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Defibrillation | Defibrillation, cardioversion (per day) | 1,213.53 |
34.71 | 38.12 | 41.54 | 45.23 |
(2.86) | (3.14) | (3.42) | (3.73) | |||
Cardiopulmonary resuscitation | Cardiopulmonary resuscitation (15min) | 1,204.32 |
268.75 | 295.19 | 321.62 | 350.26 |
(22.32) | (24.51) | (26.71) | (29.08) | |||
Bag valve mask ventilation | Mechanical ventilation: within 3hr | 512.82 |
64.35 | 70.68 | 77.01 | 83.87 |
(12.55) | (13.78) | (15.02) | (16.35) | |||
Non-invasive ventilation care | BIPAP treatment (per day) | 1,202.65 | 78.65 | 86.38 | 94.12 | 102.50 |
(6.54) | (7.18) | (7.83) | (8.52) | |||
Care of pt with ventilator | Mechanical ventilation: within 3hr | 830.15 |
70.30 | 77.21 | 84.12 | 91.62 |
(8.47) | (9.30) | (10.13) | (11.04) | |||
Chemoport needle insertion | - | - | 73.50 | 80.73 | 87.96 | 95.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Arterial catheter insertion | - | - | 64.30 | 70.63 | 76.95 | 83.80 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Intravenous catheter insertion | - | - | 18.52 | 20.34 | 22.16 | 24.13 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Nasogastric tube insertion | Nasogastric tube insertion | 168.09 | 25.75 | 28.28 | 30.81 | 33.56 |
(15.24) | (16.74) | (18.24) | (19.86) | |||
Gastric lavage | Gastric lavage: GI bleeding | 539.70 |
74.19 | 81.49 | 88.791 | 96.69 |
(13.75) | (15.10) | (16.45) | (17.52) | |||
Transcutaneous pacing | Transcutaneous cardiac pacing | 119.14 | 55.46 | 60.92 | 66.37 | 72.28 |
(46.55) | (51.13) | (55.71) | (60.67) | |||
Chest bottle change | Natural drainage and care after operation (per day) | 47.57 | 17.58 | 19.31 | 21.04 | 22.91 |
(36.96) | (40.59) | (44.23) | (48.17) | |||
Retention enema | Retention enema | 89.50 | 34.39 | 37.77 | 41.16 | 44.82 |
(38.43) | (42.21) | (45.99) | (50.08) | |||
Supervised medication of emergency drug | - | - | 19.67 | 21.61 | 23.54 | 25.64 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Hemodynamic monitoring | - | - | 39.94 | 43.87 | 47.80 | 52.05 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Triage | - | - | 17.63 | 19.36 | 21.10 | 22.98 |
(0.00) | (0.00) | (0.00) | (0.00) | |||
Mean | 46.67 | 51.26 | 55.85 | 60.82 | ||
(13.05) | (14.33) | (15.61) | (17.00) |
CR=contribution rate.
†Applied 50% additional charge for emergency practice.
ED=emergency department.
ENP=emergency nurse practitioner; ABGA=arterial blood gas analysis. POCT=point of care test; CPR=cardio-pulmonary resuscitation, NIV=non-invasive ventilation. GI=gastric intestine. Reporting data in Kim et al. (2010).
EKG=electrokardiogram; BIPAP=Bi-level positive airway pressure. Multiply one defibrillation by three.
CR=contribution rate. Applied 50% additional charge for emergency practice.