Nurse-initiated protocols in the emergency department

Abstract

Emergency departments are overcrowded. Overcrowding has resulted in resources being stretched beyond their capacity, leading to decreased patient satisfaction, increased numbers of patients leaving without being seen, and exorbitant wait times. The purpose of this project was to implement nurse-initiated protocol order sets for specific chief complaint in an attempt to decrease length of stay in a local emergency department (ED) and improve flow. Additionally, protocol order sets would allow nurses to more rapidly and legally initiate medical interventions for patients with specific chief complaints. Three chief complaints were identified as common reasons why people seek emergency care: abdominal pain, chest pain, and ankle trauma. Protocols were created to allow nurses to initiate interventions prior to a physician seeing the patient. Retrospective chart audits were done prior to the intervention. Thirty charts with a chief complaint of abdominal pain were reviewed post implementation of nurse-initiated protocols. In the audit, nurse order mean times for abdominal pain were registration-to-order time 28.3 minutes (SD=25.5 minutes), registration-to-result time 79.4 minutes (SD=28.4 minutes), and registration-to-disposition time 221.4 minutes (SD=68.2 minutes). Results of the nurse-initiated protocol study showed a decrease in registration-to-order time of 15.7 minutes and a decrease in registration-to-results time of 20.7 minutes. There was an increase in time for registration-to-disposition of 33.5 minutes. Although overall length of stay was not decreased in the study, there was a decrease in registration-to-order times and registration-to-result times. The reduction in time to initiation of patient care suggests there is a potential for future implementation and evaluation of nurse-initiated protocols.