Triage Abilities of Nurse Practitioner vs Pediatrician

Abstract

The ability of pediatric nurse practitioners (PNPs) to perform triage functions for ill children in a busy pediatric outpatient service was compared to that of a group of pediatricians. One hundred thirteen children were seen separately on arrival by a PNP and by a pediatrician.The PNPs' evaluations agreed with the pediatricians' 84% of the time. Only two significant differences were shown: PNPs were more diligent in recording patient problems, while pediatricians were better able to anticipate the need for roentgenograms and laboratory studies.The results indicate that valuable physician time may be conserved by using the PNP to perform triage in large pediatric outpatient services.

Nurse Practitioner Effectiveness

“…Spitzer et al (1974), Perrin and Goodman (1978), and Graham (1978) used criteria defined by physician groups who used the expert-judge approach. Finally, the study by Russo et al (1975) used a variant of the expert-judge approach in which a nonstudy physician was employed to serve as a tie-breaker in cases of disagreement between the nurse practitioner and the study physician over the appropriate diagnosis for a client.…”

“…In the majority of the studies and as discussed above, patients were assigned to either physicians or nurse practitioners. In a few studies, a repeatedmeasures design was used-in which the same patients were seen by both a physician and a nurse practitioner (for example, see Duncan et al, 1971;Perrin and Goodman, 1978;Ostrea and Schuman, 1975;Kaku et al, 1970;Russo et al, 1975). The repeated-measures design has one major advantage over the separate-samples approach: The need to achieve initial equalization of patient samples is eliminated.…”

“…For a fairly large number of studies, findings have included differences favoring nurse practitioners. Examples of variables for which nurse practitioners have received higher scores than physicians include: continuity of care and emphasis on preventive medicine (Bessman, 1974); completeness of history, accuracy of disposition, and interviewing skills (Perrin and Goodman, 1978); number of suggestions offered to parents (Skinner and Kahn, 1972), diligence in recording patient problems (Russo et al, 1975); communication skills and support provided to parents (Foye et al, 1977); patient's knowledge of appropriate exercises and activities (Flynn, 1974); patient acceptance and adherence to appointments (Lewis and Resnik, 1967); blood pressure and hospitalization rates (Runyan, 1975); amount of teaching, completeness of physical exams, patient satisfaction (Graham, 1978); symptomatic relief (Komaroff et al, 1976); and amount of advice offered to patients and amount of time spent listening to patients (Lewis and Linn, 1977). Even with this wide array of positive findings for nurse practitioners, the most common interpretation was that no differences existed between physician and nurse practitioner performance.…”

Comparisons of Two Types of Nonphysician Providers Using Episode Based Data*

“…Some articles involving quality of care contrast different levels of providers. For example Sox (1979) reviewed four studies (Fine and Silver, 1973;Greenfield, Friedland, Scifers, Rhodes, Black and Komaroff, 1974;Ott, Bellaire, Machotka and Moon, 1974;Russo, Gururaj, Bunye, Kim and Ner, 1975) which assessed quality of care by different levels of providers. Other authors have done similar analyses (Goldberg, Jolly, Hosek and Chu, 1981; Powers, Jdowiec and Reichelt, 1984; Ramsay, McKenzie and Fish, 1982).…”