A&E nurse practitioners
Good - but costly
In a three part study in clinical and cost effectiveness of nurse practitioners (published by the BMA in the Emergency Medicine Journal 2003; 20:158-163) a team* from Sheffield University and the Northern General Hospital have concluded that “... a nurse practitioner minor injury service can provide a safe and effective service for the treatment of minor injury. However, the costs of such a service are greater and there seems to be an increased use of out-patient services”.
The three part prospective study took place in Sheffield, where an accident and emergency (A&E() department was closing and being replaced by a nurse led minor injury unit (MIU). The first part sampled patients attending the A&E department. The second part sampled patients from a nurse-led MIU that had replaced the A&E department. In each sample, clinical effectiveness was judged by comparing the gold standard of a research assessment with the clinical assessment. Primary outcome measures were the number of errors in clinical assessment, treatment, and disposal. The third part of the study used routine data whose collection had been prospectively configured to assess the costs and cost consequences of both models of care.
Results The minor injury unit produced a safe service where the total package of care was equal to or in some cases better than the A&E care. Significant process errors were made in 191 of 1447 (13.2%) patients treated by medical staff in the A&E department and 126 of 1313 (9.6%) of patients treated by nurse practitioners in the MIU. Very significant errors were rare (one). Waiting times were far better at the MIU (mean MIU 19 minutes, A&E department 56.4 minutes). The revenue costs were greater in the MIU (MIU £41.1, A&E department £40.01) and there was a big difference in follow up rates - nurses referred 47% of patients for follow up, the A&E department referred only 27%. Thus the costs and cost consequences were greater for MIU care compared with A&E care (MIU £12.7 per minor injury case, A&E department £9.66 per minor injury case).
Study by: M Sakr, R Kendall, J Angus, A Saunders and J Wardrope, at the Accident and Emergency Department, Northern General Hospital, Sheffield, UK, and J Nicholl of the Medical Care Research Unit, University of Sheffield, UK. Contact: Jim.Wardrope@sth.nhs.uk
30.04.2003
