Efficacy of nurse practitioner management of primary care emergency visits

Objective: To assess the efficacy of nurse practitioner management of emergency visits

by means of consensus protocols integrated into the computerized medical record

system of a primary health care center.

Methods: Descriptive, cross-sectional, retrospective study. All patients seeking

appointments for same-day care within a semiurban health care district in the province

of Girona, Spain, were included consecutively between March 15 and April 15, 2010. We

evaluated the nurses application of the appropriate computerized practice protocols in

the system. Sociodemographic variables (age, sex, country of origin), care variables

(reason for the visit), and nurse variables (seniority, place of work) were analyzed. The

nurses efficacy was evaluated on the basis of revisits within 48 hours or the need for

referral to another care provider.

Results: A total of 296 visits were included. The mean (SD) patient age was 34.4 (25.5)

years; 53.3% were women and 25.3% were immigrants. Open wounds (12.5%) were

the main reason for seeking care. No revisits within 48 hours were needed in 77.4% of

the cases (80.5% of those treated by protocol did not revisit vs 73.2% of those whose

care was not protocol-guided, P=.14). Conditions treated by protocol (57.1% of the

visits) generated fewer referrals to another professional (33.1% of protocol-guided visits

were referred vs 64.6% of nonprotocol-guided visits, P<.001). Immigrants made fewer revisits for problems treated by protocol (12.1% revisited vs 29.4% when no protocol was used, P=.04). Younger patients revisited less often (mean age of 31.5 [24] years for patients not revisiting vs 41.1 [25] years for revisitors, P=.04). Conclusions: The ability of the nursing staff to manage primary care emergency visits is high. Nurse practitioner efficacy increases when a computerized protocol is available to assist in managing a case.