Daniel J. Pallin, MD, MPH reviewing Douma MJ et al. Ann Emerg Med 2016 Jul 25.

Process metrics improved a lot when nurses implemented protocols — but is this the right approach?

In many emergency departments (EDs), patients wait for hours before seeing a physician. Investigators at an inner-city Canadian ED studied the effect of implementing nurse-initiated protocols for patient management at triage. Protocols allowed acetaminophen administration for pain or fever, and initial management of suspected fractured hip (radiography, initiation of intravenous fluids), suspected ischemic chest pain (troponin testing and aspirin administration), upper abdominal pain (lab tests including urine testing), and vaginal bleeding during pregnancy (lab tests).

The investigators randomized 143 patients to receive nurse-initiated protocolized care (76 patients) or usual care (67). The median time to acetaminophen for patients presenting with pain or fever was 186 minutes faster in the intervention group. The median time to troponin testing for patients presenting with suspected ischemic chest pain was 79 minutes faster. Median ED length of stay was reduced by 224 minutes for patients with suspected fractured hip, by 232 minutes for patients with vaginal bleeding during pregnancy, and by 131 minutes for patients with upper abdominal pain.

CITATION(S):

Douma MJ et al. A pragmatic randomized evaluation of a nurse-initiated protocol to improve timeliness of care in an urban emergency department. Ann Emerg Med 2016 Jul 25; [e-pub]. 

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