The clinical effectiveness of nurse practitioners' management of minor injuries in an adult emergency department

Abstract

Background The increasing cost of healthcare in Australia demands changes in the way healthcare is delivered. Nurse practitioners have been introduced into specialty areas including emergency departments. Specific interventions are known to include the treatment and management of minor injuries, but little has been reported on their work. Objectives Examine the best available evidence to determine the clinical effectiveness of emergency department nurse practitioners in the assessment, treatment and management of minor injuries in adults. Inclusion criteria For inclusion studies had to include adult patients treated for minor injuries by nurse practitioners in emergency departments. All study designs were included. Search strategy English language articles from 1986 onwards were sought using MEDLINE, CINAHL, Embase and Science Citation Index. Methodological quality Two independent reviewers critically appraised the quality of the studies and extracted data using standardised tools. Data collection Two independent reviewers assessed the eligibility of each study for inclusion into the review and the study design used. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Data synthesis Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. For each outcome measure, results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Results Nine studies from a total of 55 participants met the inclusion criteria. Two were randomised controlled trials. Metasynthesis of research findings generated five synthesised findings derived from 16 study findings aggregated into seven categories. Evidence comparing the clinical effectiveness of nurse practitioners to mainstream management of minor injuries was fair to poor methodological quality. When comparable data were pooled, there were no significant differences (P < 0.05) between nurse practitioners and junior doctors. Conclusions The results emphasise the need for more high-quality research using appropriate outcome measures in the area of clinical effectiveness of nurse practitioners, particularly interventions that improve outcomes for presentations to emergency departments and address issues of waiting and congestion.

Evaluating new roles within emergency care: A literature review

“…Comparison studies and a meta analysis have been carried out which showed that the NPs can provide treatment that is equivalent to that of medical colleagues (Spitzer et al, 1974;Sakr et al, 1999Sakr et al, , 2003Mundinger et al, 2000;Horrocks et al, 2002;Cooper et al, 2002;Wilson et al, 2009). It is important to note however, that two of these studies examined equivalent care in primary rather than emergency care.…”

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

“…Another review of management of minor injuries by emergency NPs came to broadly the same conclusion that this was a safe and effective way of managing this patient group. 222 The evidence on the clinical effectiveness and cost-effectiveness of physician assistants was less clear. While they were found to be more reliable in assessing particular medical complaints, were more trusted with performing procedures and were approved of by ED staff and patients, there is limited evidence on whether they can improve patient flow or are a cost-effective response.…”

“…In the absence of a risk of bias assessment, it is more difficult to assess the strength of the evidence underlying the review's conclusions. Seventeen reviews 204,205,[207][208][209][210][211][212][213][215][216][217][218][219][220]222,224 were judged to have used an appropriate method to synthesise the studies. In most cases a narrative approach was used because the included studies were too heterogeneous for meta-analysis.…”

“…Risk of bias of included studies was assessed using recognised checklists or scales in 13 204,205,208,210,213,214,216,217,219,220,222,224 out of 22 reviews. In the remainder, risk of bias was either not assessed or no results were reported.…”

Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies

“…APN involves: “nurses working in advanced roles have additional training and work beyond RNs' scope of practice?” (Maier & Aiken, ). In previous research, researchers have found advanced practice nursing to be as good as or, in some cases, even better than physician‐led care (Cooper, Lindsay, Kinn, & Swann, ; Roche, Gardner, & Jack, ; Wilson, Zwart, Everett, & Kernick, ). Nurse‐led care has been shown to have a positive impact on wait times (Hiza, Gottschalk, Umpierrez, Bush, & Reisman, ; Jennings, Clifford, Fox, O'Connell, & Gardner, ), patient satisfaction (Cooper et al, ; Jennings et al, ; Martinez‐Gonzalez et al, ), and quality of care (Jennings et al, ; Martinez‐Gonzalez et al, ).…”