Wood Charene, Hurley Colleen, Wettlaufer Julie, Penque Michelle, Shaha Steven H, Lillis Kathleen
Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA.
Pediatr Emerg Care. 2007 Oct;23(10):709-12. doi: 10.1097/PEC.0b013e318155ade4.
To determine if use of nurse practitioners (NPs) for procedural sedation and analgesia (PSA) compared with physicians (MDs) decreased overall length of stay (LOS) in the pediatric emergency department (PED).
Retrospective chart review was conducted on all children (age <21 years) undergoing procedural sedation and analgesia (PSA) for 36 consecutive months at a tertiary academic children's hospital (n = 690). Data included times values for triage, evaluation by practitioner (NP, MD), sedation, discharge, and total LOS in the PED. Data collected also included medications given, patient diagnosis, and severe airway complications.
Results revealed statistically significant time-related advantages to NP-managed sedations. Both PED LOS and time to sedation were significantly lower for NPs versus MDs across diagnoses (P < 0.01). The diagnoses managed by MDs versus NPs were significantly different for 3 diagnoses: fracture, finger, and lacerations. There were no differences between NP and MD for severe airway complication rates.
Overall LOS and time to sedation were significantly improved when NPs independently managed patients requiring PSA without an increase in documented severe airway complication rates.
确定在儿科急诊科（PED）中，与医生（MD）相比，使用执业护士（NP）进行程序性镇静和镇痛（PSA）是否能缩短总体住院时间（LOS）。
对一家三级学术儿童医院连续36个月接受程序性镇静和镇痛（PSA）的所有儿童（年龄<21岁）进行回顾性病历审查（n = 690）。数据包括分诊时间、执业人员（NP、MD）评估时间、镇静时间、出院时间以及在PED中的总住院时间。收集的数据还包括所用药物、患者诊断和严重气道并发症。
结果显示NP管理的镇静在时间方面具有统计学上的显著优势。在所有诊断中，NP管理的患者在PED的住院时间和达到镇静的时间均显著低于MD管理的患者（P < 0.01）。MD和NP管理的诊断在3种诊断上存在显著差异：骨折、手指伤和撕裂伤。NP和MD在严重气道并发症发生率方面没有差异。
当NP独立管理需要PSA的患者时，总体住院时间和达到镇静的时间显著改善，且记录的严重气道并发症发生率没有增加。
