The implementation of the process nurse in an emergency department: evaluation of the clinical impact

Abstract

The nursing management of uncomplicated trauma in the emergency department (ED) may be beneficial. Following a training programme based on evidence-based practice, the process nurse (PN) was implemented in an ED in Turin, Italy. To assess the impact of the PN on the management of patient flow in the ED, with a particular focus on uncomplicated trauma. An observational study was conducted on patients admitted to the ED with minor traumas in the year before and after the implementation of the PN. The characteristics of the sample and differences in mean time taken before the start of the diagnostic pathway and the overall stay in the ED were investigated, as well as the number of triage re-assessments. A total of 24,900 ED users for traumatic problems, mostly with medium-low priority codes, were analysed. The drop-out rate before physician visit was significantly reduced (2.5% vs 0.5%; p <0.01), as was the waiting time before the start of the diagnostic pathway (p <0.01); the overall time spent in the ED was reduced by more than two hours (p <0.01), as well as the number of triage re-assessments during waiting time (p <0.01). Training programmes for emergency nurses and the implementation of the PN significantly impacted on the clinical and organizational outcomes, influencing drop-out rate and length of stay in the ED. Nursing management of selected users before physician examination may prevent overcrowding.