Nurse-Initiated Protocol Improves Timeliness of ED Care

A new study demonstrates how carefully written nurse-initiated protocols can dramatically reduce time spent in the emergency department (ED) for certain targeted patients.

Researchers at the University of Toronto (Canada) and Royal Alexandra Hospital (Edmonton, Canada) conducted a computer-randomized, pragmatic, controlled evaluation of six nurse-initiated protocols in a busy, crowded, inner city ED as a potential strategy to improve patient flow. The primary outcomes included time to diagnostic test, time to treatment, time to consultation, or ED length of stay.

The results revealed that nurse-driven protocols reduced the median time taken to administer the analgesic acetaminophen to ED patients with pain or fever by over 3 hours, and decreased average time to troponin testing for ED patients with chest pain suspected to be heart attack by 79 minutes. ED length of stay was reduced by 224 minutes by implementing a suspected fractured hip protocol, and a vaginal bleeding during pregnancy protocol reduced median ED length of stay by nearly four hours. The study was published on July 29, 2016, in Annals of Emergency Medicine.

“Nurse-driven protocols are not an ideal solution, but a stop-gap measure to deal with the enormous problem of long wait times in emergency departments, especially for patients with complex problems,” said lead author clinical nurse educator Matthew Douma, RN, BSN. “Given the long waits many emergency patients endure prior to treatment of pain, the acetaminophen protocol was a quick win. Emergency department crowding will continue to require broad and creative strategies to ensure timely care to our patients.”

There are basically two types of protocols used in the ED - protocols meant to speed patient care and protocols meant to standardize patient care. The result is that instead of waiting for a doctor to order common baseline tests, nurses may order the tests immediately according to established protocols, getting a head-start on the tests that the doctor will require. For examples, a patient entering the ED with a respiratory complaint will have already undergone the relevant tests by the time the doctor is able to see the patient, allowing appropriate care earlier in the process.

Related Links:
University of Toronto
Royal Alexandra Hospital