Using Nurse-Initiated Protocols to Improve Patient Flow

Listening to Hear Rate

Busy emergency departments looking to reduce crowding and improve patient flow may not have to look much further than nurse-initiated protocols, a study from the Annals of Emergency Medicine suggests. By allowing nurses to initiate diagnostic tests and provide treatment prior to the patient seeing a physician or nurse practitioner, EDs saw a significant reduction in ED length of stay (LOS) and improved patient flow. Could this type of effort help your ED?

The study, entitled A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department, looked at six nurse-initiated protocols implemented in an overcrowded ED. They then evaluated the effect these protocols had on LOS and times related to diagnostic testing, treatment and consultation.

And the results were promising. The study found that:

  • Nurse-initiated protocols resulted in an 186-minute decrease of the median time it took for patients presenting with pain or fever to receive acetaminophen.
  • A suspected hip fracture protocol resulted in median length of stay decrease of 224 minutes.
  • A protocol targeting pregnant women presenting with vaginal bleeding led to a median LOS decrease of 232 minutes.
  • The ED was able to cut the median time to troponin testing for patients presenting with suspected ischemic chest pain by 79 minutes.

The researchers concluded that “targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay.” That should motivate ED leaders to consider implementing their own set of nurse-initiated protocols, if they haven’t already.

Are there any nurse-initiated protocols your hospital has implemented to improve patient flow that others can benefit from? Which ways have you seen improvements? Are there certain conditions you feel are prime for these type of protocols and could see benefits?

When it comes to patient satisfaction and your hospital’s bottom line, improving patient flow is a smart place to start. If you’re an ED or hospital leader interested in learning more about nurse-initiated protocols and how they can help alleviate crowding in your ED, my company, Donovan+Partners can help. We can assess your current patient flow process and determine which protocols should be established to improve flow, while continuing to provide the highest quality of care for your patients with safety in mind. Please reach out. I love helping EDs maximize efficiency to improve patient care and would love to chat with you.

Also, in case you missed it, check out my blog from last week on one of the first steps in improving patient flow — improving the EMS-to-ED handoff. It covers four strategies you can implement to improve communication and as a result, patient well-being. Several of you also offered your suggestions for improving the handoff of patients from emergency services specialists to emergency department staff.

As a follow-up, how often does your emergency department staff and emergency services personnel exchange interdisciplinary feedback and talk about scope of practice between out-of-hospital and hospital-based providers? How do you go about sharing?


Source: Annals of Emergency Medicine: “A Pragmatic Randomized Evaluation of a Nurse-Initiated Protocol to Improve Timeliness of Care in an Urban Emergency Department.”