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Nurse-Driven Protocols Reduce Lengths of Stay for Some ED Patients

EDMONTON, ALBERTA – If your emergency department is looking for a way to shorten length of stay for certain common conditions, the answers might be all around you. Literally.

A new Canadian study published in Annals of Emergency Medicine suggests that protocols permitting nurses to administer specific types of ED treatment can significantly shorten length of stay (LOS) for patients with fever, chest pain, hip fractures, and vaginal bleeding during pregnancy.

“For certain patients, nurse-driven protocols can dramatically decrease the amount of time they spend in the emergency department,” explained lead author Matthew Douma, RN, BSN, clinical nurse educator at Royal Alexandra Hospital in Edmonton, Alberta. “Emergency department crowding is a common and complicated problem, so anything we can do to get our patients treated and discharged is to the good. It helps everyone in the ER by reducing crowding.”

The Joint Commission mandates that any nurse-driven protocols must be written so that there is no doubt as to the requirements needed to implement them and should take nationally recognized and evidence-based guidelines into account.

In this case, evaluation of the six nurse-initiated protocols occurred in a busy, crowded, inner-city ED. Researchers measured them against primary outcomes, including time to diagnostic test, time to treatment, time to consultation, or ED length of stay.

Results indicate that the nurse-driven protocols decreased the median time to administer acetaminophen to ED patients with pain or fever by more than three hours. In addition, those types of protocols decreased average time by 79 minutes for troponin testing of patients with chest pain suspected to be heart attack, while average LOS was reduced by almost four hours for patients presenting with fractured hips and with vaginal bleeding.

“Given the long waits many emergency patients endure prior to treatment of pain, the acetaminophen protocol was a quick win,” Douma pointed out in an American College of Emergency Physicians press release. “That said, 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. Emergency department crowding will continue to require broad and creative strategies to ensure timely care to our patients."

PDMR - Pediatric Emergency Medicine Reports-hz-v2