Begaz Tomer, Elashoff David, Grogan Tristan R, Talan David, Taira Breena R
Department of Emergency Medicine, David Geffen School of Medicine, Olive View UCLA Emergency Medicine, Sylmar, CA, United States.
Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
Am J Emerg Med. 2017 Oct;35(10):1426-1429. doi: 10.1016/j.ajem.2017.04.027. Epub 2017 Apr 14.
To compare diagnostic test ordering practices of NPs with those of physicians in the role of Provider in Triage (PIT).
This was a secondary analysis of data from a prospective RCT of waiting room diagnostic testing, where 770 patients had diagnostic studies ordered from the waiting room. The primary outcome was the number of test categories ordered by provider type. Other outcomes included total tests ordered by the end of ED stay, and time in an ED bed. We compared variables between groups using t-test and chi-square, constructed logistic regression models for individual test categories, and univariate and multivariate negative binomial models.
Physicians ordered significantly more diagnostic test categories than NPs (1.75 vs. 1.54, p<0.001). By the end of their ED stay, there was no significant difference in total test categories ordered between provider type: physician 2.67 vs. NP 2.53 (p=0.08), using a nonbinomial model, incidence rate ratio (IRR) 1.07 (0.98-1.17). Patient time in an ED bed was not significantly different between physicians and NPs (NP 244min, SD=133, Physicians 248min, SD=152) difference 4min (-24.3-16.1) p=0.688.
NPs in the PIT role ordered slightly less diagnostic tests than attending physicians. This slight difference did not affect time spent in an ED bed. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types. PIT staffing with NPs does not appear to be associated with excess test ordering or prolonged ED patient stays.
比较在分诊提供者（PIT）角色中，执业护士（NPs）与医生的诊断检查开单行为。
这是一项对来自候诊室诊断检查前瞻性随机对照试验数据的二次分析，其中770例患者在候诊室接受了诊断检查。主要结局是按提供者类型开单的检查类别数量。其他结局包括急诊留观结束时开单的检查总数以及在急诊床位的停留时间。我们使用t检验和卡方检验比较组间变量，构建了各检查类别的逻辑回归模型以及单变量和多变量负二项式模型。
医生开单的诊断检查类别显著多于执业护士（1.75对1.54，p<0.001）。到急诊留观结束时，按提供者类型开单的检查总类别无显著差异：医生为2.67，执业护士为2.53（p=0.08），使用非二项式模型，发病率比（IRR）为1.07（0.98 - 1.17）。医生和执业护士在急诊床位的患者停留时间无显著差异（执业护士244分钟，标准差 = 133，医生248分钟，标准差 = 152），差异为4分钟（-24.3 - 16.1），p = 0.688。
在PIT角色中的执业护士开单的诊断检查略少于主治医生。这种细微差异并未影响在急诊床位的停留时间。到急诊留观结束时，按提供者类型开单的检查总类别无显著差异。由执业护士进行PIT人员配置似乎与过度开单检查或延长急诊患者留观时间无关。
