Emergency nurse practitioners: do they provide an effective service in managing minor injuries, compared to emergency medicine registrars?

Abstract

AIM: To determine whether emergency nurse practitioners (ENPs) are as equivalent to emergency medicine (EM) registrars in minor injury management in a New Zealand environment. METHOD: A Prospective observational audit (chart review) of a non-consecutive cohort of patients with minor trauma was conducted. The primary outcome measure was length of stay. The secondary outcome measures were: time waiting to be seen, number of unexpected returns, missed injury rate and the number of patients who left the department without being seen. Data was analysed using standard statistical methods using Statview v5.0 (SAS) software. RESULTS: 420 patients were included; ENP group n=305, EM registrar group n=115.The ENPs, saw more males (70% versus 59%, p=0.03), younger (30 years versus 41 years, p=0.0004) and lower acuity patients (p<0.0001). After adjustment for age, gender and acuity, median ED length of stay was longer in EM registrar group by 40 minutes, p<0.0001, and the time to be seen was longer in the EM registrar group by 36 minutes, p<0.0001. Treatment times were equivalent. The missed fracture rate was 1% in both groups. The unexpected return rate was 2% in the ENP group and 1% in the EM registrar group. Left without being seen rate was 5%. CONCLUSION: ENPs appear to "sign on" to see minor injury patients faster than EM registrars, which may account for the reduced length of stay for ENP treated patients.