Should accident and emergency nurses request radiographs? Results of a multicentre evaluation.

Abstract

Results-There was a significant reduction in the time spent in A&E when no radiograph was requested (P << 0-001). The mean time saved in the "Doctor First" (DF) group was 51 min, and in the "Nurse First" (NF) group 36 min. For those who were sent for an x ray 14 min was saved by getting the patient to see the nurse first. However, because the overall referral rate for x rays was greater in the NF group, (78% ofpatients compared with 74% of the DF group, a significant 40/o increase (P=0.05) this potential benefit was largely lost. Overall the average waiting time in the DF group of 92*5 min (95% confidence interval: 89-2 to 96-1 min) was reduced to 88'5 min (95% CI: 85 2 to 91-8 min) in the NF group, a non-significant saving of 4 min. There was no overall difference between the proportion of relevant abnormalities reported by the radiologists for the DF or NF groups (G2 = 0-739, ldf, P = 0-30); however, there was a significant association between the number of relevant abnormalities reported by the radiologists and the different hospitals (G2 = 9'7626, 3df, P = 0-02).Hospital C had the highest abnormality rate reported by the radiologists in both the DF (450/o) and the NF (51%) groups.The most time saved in A&E was in the DF category when comparing those who did not have an x ray [58][59][60][61][62][63] (_Accid Emerg Med 1996;13:86-89)

Review article: Systematic review of three key strategies designed to improve patient flow through the emergency department

“…NI X‐rays, which is the ordering of diagnostic testing before medical officer (MO) review, showed varied effects on patient flow. Two studies noted little impact on ED LOS and wait times, but another indicated time to diagnosis and treatment was reduced (from 102.7 min to 65.5 min, P < 0.001) . Different sample selection, nursing staff designation and levels of training and departmental busyness might impact on these outcomes and thus the broader applicability of the findings.…”

“…Expanding the roles/scope of nursing services to meet health service demands is an important aspect of ED throughput . Nursing roles now include CINs and NPs.…”

“…Expanding the roles/scope of nursing services to meet health service demands is an important aspect of ED throughput. [27][28][29][30]32,35,47 Nursing roles now include CINs and NPs. Evidence of the impact of these developing roles on ED flow indicators is varied ( Table 2).…”

A protocol helps emergency triage nurses to request X‐rays

“…There is a need for further development of objective protocols in order to reduce the number of unnecessary X‐rays requested. This would result in cost savings and reduce patients length of stay in the emergency department 9,10 .…”

Establishing an emergency nurse practitioner service

“…10 Thurston and Field investigated whether waiting time in A&E departments is shortened when experienced nurses request peripheral limb radiographs before a patient is assessed by a doctor, and found that 14 minutes can be saved by arranging for the patient to see the nurse first, but nurses tended to request more radiological examinations than doctors, and they concluded that specific training and constant monitoring are essential. 11 Freij et al compared the ability of nurse practitioners and SHOs to request and interpret a limited range of radiographic views of patients attending a minor injuries unit, and found that appropriately trained nurse practitioners are at least as good as SHOs in recognising the need for a radiograph and are as competent in their interpretation. 12 Sakr et al did not find that nurse practitioners requested radiography more frequently than doctors; both groups interpreted the radiographs with equal accuracy.…”