Abstract
BackgroundEmergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol.MethodsAn economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle and foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups with the difference in sensitivity and specificity between groups in diagnosing fractures and severe sprains. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane.ResultsNo significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were € 186 (SD € 623) for patients in the SEN group and € 153 (SD € 529) for patients in the HO group. The difference in total costs was € 33 (95% CI: – € 84 to € 155). The incremental cost-effectiveness ratio was € 27 for a reduction of one missed diagnosis and € 18 for a reduction of one false negative.ConclusionConsidering the benefits of the SEN-concept in terms of decreased workload for the ED physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED crowding.
Highlights
Emergency Departments (EDs) are confronted with progressive overcrowding
The percentage of false positives and false negatives in the Specialized Emergency Nurse (SEN) group was 7.4% compared with 8.6% in the House Officers (HOs) group
SENs accomplished these results with better patient satisfaction results than did the HOs
Summary
The workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol. Crowding causes late diagnoses with the possibility of unnecessary complications To cope with these problems, Advanced Nurse Practitioners (ANPs) and Physician Assistants (PAs) were introduced to take over certain diagnostic tasks from doctors to alleviate the physicians of some of the workload in the ED [3]. There are some disadvantages to the development: training is relatively long and expensive and trainees are withdrawn from the already tight nurses pool [7,8] To resolve these disadvantages and maintain the benefits of these practitioners, we conceived a new concept: the Specialized Emergency Nurse (SEN). SENs are trained to be flexible employees capable of treating common injuries alongside their regular nursing duties
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