Determination of emergency nurse practitioner and plastic surgery trainee disposition decision agreement for plastic surgery emergency department presentations: A prospective study.

Abstract

To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub-analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non-OM groups were analysed. The study recruited 342 patients who presented mostly with finger or hand-related conditions (82%, n=279) and managed by an ENP with less than 10 years of experience (65%, n=224). Disposition decisions by ENP compared to PST were the same in 80% (n=274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66-0.78). For the OM and non-OM groups, disposition decisions were the same in 94% (n=320), with a Cohen's kappa 0.85 (95% confidence interval 0.79-0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.