Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries

Volume 36, Issue 4, Pages 311-316 (July 2010)

Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries

Christien van der Linden, RN, MANU, MSCE, Resi Reijnen, MD, Rien de Vos, PhD


Received 29 September 2008; received in revised form 26 July 2009; accepted 11 August 2009. published online 09 December 2009.

Introduction
Our objectives were to determine the incidence of missed injuries and inappropriately managed cases in patients with minor injuries and illnesses and to evaluate diagnostic accuracy of the emergency nurse practitioners (ENPs) compared with junior doctors/senior house officers (SHOs).

Methods
In a descriptive cohort study, 741 patients treated by ENPs were compared with a random sample of 741 patients treated by junior doctors/SHOs. Groups were compared regarding incidence and severity of missed injuries and inappropriately managed cases, waiting times, and length of stay.

Results
Within the total group, 29 of the 1,482 patients (1.9%) had a missed injury or were inappropriately managed. No statistically significant difference was found between the ENP and physician groups in terms of missed injuries or inappropriate management, with 9 errors (1.2%) by junior doctors/SHOs and 20 errors (2.7%) by ENPs. The most common reason for missed injuries was misinterpretation of radiographs (13 of 17 missed injuries). There was no significant difference in waiting time for treatment by junior doctors/SHOs versus ENPs (20 minutes vs 19 minutes). The mean length of stay was significantly longer for junior doctors/SHOs (65 minutes for ENPs and 85 minutes for junior doctors/SHOs; P < .001; 95% confidence interval, 72.32-77.41).

Discussion
ENPs showed high diagnostic accuracy, with 97.3% of the patients being correctly diagnosed and managed. No significant differences between nurse practitioners and physicians related to missed injuries and inappropriate management were detected.

Key words: Emergency department, Emergency nurse practitioner, Diagnostic accuracy, Diagnostic errors, Length of stay
The Hague, The Netherlands

For correspondence, write: Christien van der Linden, RN, MANU, MSCE, Accident and Emergency Department, Medical Center Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands

Earn Up to 8.5 CE Hours. See page 392.

PII: S0099-1767(09)00389-4

doi:10.1016/j.jen.2009.08.012

© 2010 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries