Division of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
CJEM. 2004 Jul;6(4):246-52. doi: 10.1017/s1481803500009209.
It may be appropriate for nurse practitioners (NPs) to provide care for a subset of emergency department (ED) patients with non-urgent problems. Our objective was to determine the attitude of ED patients with minor problems to being treated by an NP.
Consecutive adults who presented to this tertiary ED on weekdays between 8 am and 4 pm were eligible for the study if they had 1 of the following 18 complaints: minor abrasions or lacerations, minor bites, minor burns, minor extremity trauma, cast check, earache, superficial foreign body, lice or pinworms, morning-after pill request, needlestick injury or body-fluid exposure, prescription refill, puncture wound, sore throat, subconjunctival hemorrhage, suture removal or wound check, tetanus immunization request, toothache, or urinary tract infection (women). Unless pain or a language barrier precluded study involvement, a triage nurse gave each patient a brief survey to be completed prior to physician assessment.
Of 728 eligible patients during the study period, 246 (34%) were invited to participate and 213 (87%) were enrolled. The mean age was 34.5 years, and 58% were men. When asked about their willingness to be treated by an NP, 72.5% said "yes" (95% confidence interval [CI], 65.8%-78.4%), 15.5% were "uncertain" (95% CI, 10.8%-21.1%) and 12.1% said "no" (95% CI, 8.0%-17.3%). Of those who said "yes," 21% expected to also see an emergency physician during their ED visit and 67% did not. Willingness to be treated by an NP was independent of age, gender or educational status.
A majority of ED patients with minor problems accepted being treated by an NP, often without additional physician assessment. Several factors, including impact on ED staffing and patient flow, logistics, cost and quality of care should be evaluated before implementing such strategies.
对于执业护士（NPs）来说，为具有非紧急问题的急诊部（ED）患者亚组提供护理可能是合适的。我们的目的是确定具有轻微问题的 ED 患者接受 NP 治疗的态度。
如果成年人在每周工作日的上午 8 点至下午 4 点之间到这个三级 ED 就诊，并且他们有以下 18 种抱怨之一，则符合研究条件：轻微擦伤或撕裂伤，轻微咬伤，轻微烧伤，轻微四肢创伤，石膏检查，耳痛，表面异物，虱子或蛲虫，紧急避孕药请求，针刺痛或体液暴露，处方续药，穿刺伤口，咽痛，眼结膜下出血，拆线或伤口检查，破伤风免疫接种请求，牙痛或尿路感染（女性）。除非疼痛或语言障碍妨碍研究参与，否则分诊护士会在医生评估之前为每位患者提供一份简短的调查。
在研究期间，728 名符合条件的患者中有 246 名（34%）被邀请参与，其中 213 名（87%）被纳入研究。患者的平均年龄为 34.5 岁，其中 58%为男性。当被问及是否愿意接受 NP 治疗时，72.5%的患者回答“是”（95%置信区间，65.8%-78.4%），15.5%的患者回答“不确定”（95%置信区间，10.8%-21.1%），12.1%的患者回答“否”（95%置信区间，8.0%-17.3%）。在那些回答“是”的患者中，21%的人期望在 ED 就诊期间也能看到急诊医生，而 67%的人不期望。是否愿意接受 NP 治疗与年龄、性别或教育程度无关。
大多数患有轻微问题的 ED 患者接受 NP 治疗，通常不需要额外的医生评估。在实施此类策略之前，应评估包括对 ED 人员配备和患者流程的影响、后勤、成本和护理质量在内的几个因素。
