Original contributionCorrelation between triage nurse and physician ordering of ED tests☆
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Cited by (28)
Ordering Characteristics Predictive of Noncontrast CT Head Positivity in the Emergency Department
2023, Academic RadiologyCitation Excerpt :It is important to note that we evaluated exam positivity between the groups as an attempted comparative measure of over/underutilization but recognize that in several clinical scenarios a “negative” noncontrast Head CT can acutely change patient management and therefore may not necessarily be a byproduct of over-utilization. Our data is relatively discordant with prior work demonstrating that NP/PAs in comparison to physicians order excessive imaging studies in the outpatient clinic setting as well as the Emergency Department (12-14). This difference may be explained by the fact that the noncontrast head CT is unique in comparison to the broader scope of imaging and serves to answer a specific subset of clinical questions which likely have a higher degree of clinical concordance between NP/PAs and physicians in the ED setting.
Triage Nurse-Ordered Testing in the Emergency Department Setting: A Review of the Literature for the Clinician
2021, Journal of Emergency MedicineCitation Excerpt :All three studies found reasonably good correlation between physicians and triage nurse-ordered imaging protocols, with 10.9% to 12.9% disagreement in two studies and a kappa of 0.65 to 0.68 in the third (11,17,18). One study analyzed the correlation between physician and triage nurse-ordered laboratory protocols, demonstrating a moderate correlation for laboratory studies (k = 0.48 to 0.54) (17). The problem of “overcrowding” in EDs continues to grow, with deleterious effects on the quality of care.
Experimental design and simulation applied to a paediatric emergency department: A case study
2019, Computers and Industrial EngineeringCitation Excerpt :First, ED managers and physicians tend to be sceptical about the appropriateness of allowing nurses to prescribe, and second, parents tend to press for a physician’s assessment before submitting their children to tests they perceive as painful or harmful (e.g. blood tests, X-rays). However, evidence from general EDs (Fry, 2001; Lee et al., 1996; Seaberg & Macleod, 1998) suggests that nurses’ prescriptions do not differ significantly from those of physicians. Given that complementary examinations such as lab tests and radiology exams strongly determine patient LOS (Gardner, Sarkar, Maselli, & Gonzales, 2007), allowing a nurse to prescribe such tests early in the process (i.e. during triage) seems a promising way of reducing LOS and rationalising the utilisation of consultation rooms and physicians.
Registered nurse scope of practice and ED complaint-specific protocols
2013, Journal of Emergency NursingCitation Excerpt :Likewise, the nurse may select a different set of orders from within an abdominal pain protocol for an elderly man with alcoholism who has upper right quadrant abdominal pain than for a sexually active, otherwise healthy, young female patient with pelvic pain. However, studies on the use of CSPs in the emergency department either do not outline the training offered, relay the training as a brief (1-hour) site-specific orientation, or assume that knowledge and skills are acquired through practice experience.3,4,18-20 Development of a standardized education program, modeled after Emergency Severity Index training,33 with documentation of individual RN knowledge, skill, and competency is indicated for states where CSPs may be allowed in the RN’s scope of practice.26
Expanding nurse initiated X-rays in emergency care using team-based learning and decision support
2013, Australasian Emergency Nursing JournalOptimizing Emergency Department Front-End Operations
2010, Annals of Emergency MedicineCitation Excerpt :Protocols for medication administration (eg, oral analgesia for pain35) ordering of imaging studies (eg, radiograph for ankle injury),33,34 institution of elopement precautions,36 and initial management for disease-specific states (eg, pneumonia37) have been studied. Before the implementation of advanced triage protocol, one institution recorded only a 41% agreement between physician-directed test ordering and tests ordered by a triage nurse, with notable nurse overordering (35%) and underordering (37%) compared with that of sample physicians (class II).32 Implementation of advanced triage protocol improved the correlation between triage nurse and physician test ordering to 57% (P=.0042).
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Supported by the Emergency Medicine Association of Pittsburgh.
Presented at the American College of Emergency Physicians Scientific Assembly, February 1995, San Francisco, CA, and the Pennsylvania Chapter of the American College of Emergency Physicians Annual Scientific Meeting, April 1993, Harrisburg, PA.