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 present…
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DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals
DisclosuresConsultant/Advisory BoardPortola Pharmaceuticals, Inc.
Speaker’s BureauPeerView Institute for Medical Education
Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals