Triage Nurse-Ordered Diagnostic Studies – An Evolving Strategy to Reduce Emergency Department Length of Stay?

Excerpt

Every child seeking emergency care needs to be assessed by experienced health care providers as early as possible to identify those requiring urgent attention. However, overcrowding in pediatric emergency room (ED) of referral centres is common. Overcrowding affects the effective functioning, resulting in poor outcomes, increased patient waiting times, length of stay and parental dissatisfaction [1]. Triaging patients to identify those having serious illness helps in reducing the time to receive life support therapies. Despite triaging, overcrowding in ED with less serious illnesses continues to be an important concern. To overcome this challenge,various strategies like streaming, fast tracking, point of care testing, nurse driven diagnostic test ordering, and team triaging have been found to be useful [2]. Among these, fast tracking of patients with less serious symptoms has the strongest evidence base [2]. Training the nursing staff to order simple investigations that could help physicians to decide further treatment; while awaiting their turn for physician consultation seems to be a promising option to improve patient satisfaction and decrease the length of stay (LOS). Three studies on triage-nurse ordered radiographs reported decrease in the ED LOS by 20 min in adults with ankle injury [3]. The diagnostic accuracy of nurse’s clinical assessment should not be underestimated as it was found to match that of the physicians for certain diseases [4]. …