Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled t

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Care of minor injuries by emergency nurse
practitioners or junior doctors a randomised
controlled trial

• M Sakr, J Angus, J perrin, C Nixon, J Nicholl, J
  Wardrope
• The Lancet vol 354 October 16, 1999

91-08-17 ??? ???
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Question

• Can nurse practitioner (NSP) be an alternative to
  junior doctor in managing minor injury in ER?

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Objective

• To assess the care and outcome of patients with
  minor injuries who were managed by a nurse
  practitioner (NSP) or a junior doctor (JD) in ER

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Inclusion criteria

• Patient visited ER with 6-month period and during
  study session
• Patient with minor trauma, with informed consent
• Only injury that was treatable by NSP
• Not previously assessed by GP

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Criteria of assessment

• Adequacy of care
• Satisfaction of care reported by patient via
  questionnaires
• Work rate and cost

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Adequacy of Care

• Compared clinical assessment of NSP and JD with
  research registrar
• Criteria included
• Clinical examination
• Request for radiography
• Treatment decision
• Advice
• Follow up
• Reviewed by ER consultants 3 month later

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Questionnaires

• At ER
• Satisfaction of care
• Courtesy
• Care facilities

• 28 days later
• Need unplanned F/U ?
• Recovery and capacity for work, leisure, daily
  living
• Overall satisfaction of care received

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Work Rate and Cost

• Direct observation of time taken by JD and NSP to
  take history, examine the patient, interpret the
  radiographs, and record their findings for 100
  patient
• Cost for staff and training course

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Adequacy of Care
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Patient Satisfaction
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Satisfaction At ER

• 831 patients completed questionnaires at ER
• 11 reported poor or very poor
• 3/387(0.8) in NSP group
• 8/415 (1.9) in JD group
• P0.04

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Outcome at 28 Days
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Work Rate and Cost

• JD
• 48 patients
• 9.02 (SD 4) min
• Salary Cost
• 14.91/hr

• NSP
• 46 patients
• 10.89 (SD 4.6) min
• Salary Cost
• 12.18/hr on weekday
• 15.81/hr on Sat night
• 19.44/hr on Sunday
• 1370 850 for 3 wks training

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Discussions

• Assessed long term outcome of pt care by NSP
• No increased frequency of request for
  radiography by NSP
• Same accuracy of radiography interpretation by
  NSP and JD
• NSP provided better care as indicated by less
  unplanned F/U

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Discussions (2)

• Despite higher cost in NSP training, NSP is
  permanent staff but JD rotates every 6 month and
  require same training
• This study shows that nurse practitioners can
  provide a safe alternative to junior doctors for
  the care of patients with minor injuries.

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Thank You!