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Efficacy of nurse practitioner management of primary care emergency visits

Pascual M, Gené E, Arnau R, Pelegrí M, Pineda M, Azagra R

ABS Arbúcies-St Hilari, Girona, Spain. Servei d’Urgències, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Universitat Autònoma de Barcelona, Cerdanyola, Spain. CIBERehd, Instituto de Salud Carlos III, Spain. EAP Badia del Vallés, USR-MNord-IDIAP Jordi Gol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Cerdanyola, Spain.

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 nursesÂ’ 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
nursesÂ’ 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.

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