Nurse-driven protocols shorten ED stays, study finds


When nurses are allowed to administer certain treatments in the emergency department, instead of physicians, it can shorten ED stays for patients with fever, chest pain, hip fractures and vaginal bleeding, according to a study in Annals of Emergency Medicine.

An urban Canadian hospital with a 55-bed ED evaluated six nurse-initiated protocols' effect on ED length of stay. The six protocols were in the following areas:

  • Acetaminophen for pain and fever
  • Suspected hip fracture
  • Chest pain
  • Vaginal bleeding during pregnancy
  • Lower abdominal pain
  • Upper abdominal pain

Eligible patients in the ED were randomly assigned to either the nurse-driven protocol group or the control group during a 45-day period. The protocol group involved 76 patients, and the control group had 67 patients.

Letting nurses lead for pain and fever, hip fracture, chest pain and vaginal bleeding during pregnancy had a major effect on those patients' length of stay in the ED. The protocols decreased the median time to administer acetaminophen to emergency patients with pain or fever by more than three hours and decreased average time to troponin testing for emergency patients with chest pain suspected to be heart attack by 79 minutes. Additionally, average length of stay for fractured hip patients was reduced by almost four hours, and the nurse-driven vaginal bleeding during pregnancy protocol reduced average length of stay in the ED by nearly four hours as well.

"Targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay," the authors concluded.

Despite their success, Matthew Douma, clinical nurse educator at Royal Alexandra Hospital in Edmonton, Alberta, said the nurse-driven protocols shouldn't be seen as a silver bullet solution to ED crowding.

"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," Mr. Douma said. "Emergency department crowding will continue to require broad and creative strategies to ensure timely care to our patients."

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