We can help patients faster and better by giving nurses in
accident and emergency departments more responsibility. That is one
of the findings of research by Remco Rosmulder of the University of
Twente. He carried out trials of a new protocol for the
registration of patients, and his findings will be published next
month in a Dutch medical journal (Nederlands Tijdschrift voor
Geneeskunde).
When a patient arrives at a hospital's accident and emergency
department, it often takes some time before he or she is seen by a
doctor and the treatment can be started. To avoid patients having
to wait too long for a doctor, a triage procedure is carried out by
a specially trained nurse, using a protocol to ensure that the
patients in the most acute need are treated first. Business
Engineering specialist Remco Rosmulder of the University of Twente
carried out research at the Academic Medical Centre in Amsterdam
into a different method with a more detailed protocol. Using this
more detailed protocol, the nurse can directly request diagnostic
examinations such as X-rays, laboratory tests and ECGs. The benefit
for the patient is that the first examination procedures are
already underway (and the results may already be available) by the
time the patient meets the doctor who will carry out the
treatment.
The research showed that with the new method the time spent by
patients in the accident and emergency department was reduced by 14
percent, while the quality of the treatment was still assured. The
nurse's diagnostic indication was correct and the examination
request was complete for 93 percent of the patients. The quality of
the requests for X-rays was the same as it was before the
introduction of the protocol. Not only the nurses, but also the
doctors were enthusiastic about the method, and Rosmulder is
calling for its introduction on a wider scale.
Method
In Rosmulder's research a method known as advanced triage was
used when patients were admitted to the accident and emergency
department. With this method a specially trained nurse can request
diagnostic examinations such as X-rays, laboratory tests and ECGs
as soon as the patient arrives. The method is already used in the
USA and elsewhere, but the protocol used by the nurses here was
specially developed for the Dutch situation. During the research
project the accident and emergency doctor providing treatment
checked afterwards whether the supplementary diagnosis had been
requested by the nurse correctly and completely. Two
traumatologists and two radiologists independently evaluated the
quality of the requests for X-rays. A total of 704 patients were
involved in the research.
Note to editors
Remco Rosmulder carried out his research within the IGS
Institute for Governance Studies and the Operations,
Organization and Human Resources
(OOHR) department of the Faculty of Management and
Governance. His tutors were Prof. Koos Krabbendam and Prof. Toon
Kerkhoff of the University of Twente and Erik Schinkel, Dr Ludo
Beenen and Jan Luitse of the Academic Medical Centre in Amsterdam.
The findings of the research are described in an academic article
that will appear in April in the Dutch Medical Journal
(Nederlands Tijdschrift voor Geneeskunde).
The article has already been published online on the journal's
website.
Contact for the press: Joost Bruysters, tel.
+31 (0)53 489 2773 / +31 (0)6 1048 8228
