The effectiveness of nurse-initiated interventions in the Emergency Department. A systematic review and meta-analysis.

Mr Luke Burgess1
1Mater Misericordiae Ltd, West End Brisbane, Australia

Introduction: Nurse-initiated interventions can provide early intervention for time sensitive presentations to the Emergency Department. This review summarises the current evidence for nurse-initiated practices within the Emergency Department.
Results: Twenty-three studies were included in the final review. Seven studies investigating time-to-analgesia found reductions in average time-to-analgesia ranging from three to 91 minutes. Time-to nurse-initiated corticosteroids was significantly improved in the three studies that introduced this intervention, with improvements of 22.8, 39 and 49.52 minutes. Meta-analysis strongly favoured time-to-treatment for nurse-initiated beta-agonist treatment for acute respiratory distress (MD = -35.45, 95% CI: -41.83, -29.07).  Nurse-initiated analgesia resulted in a higher likelihood of receiving analgesia in the Emergency Department (OR 1.41 [1.20, 1.67]). 75% of  studies reported significant decreases in pain when nurse-initiated analgesia was used. Respiratory distress was significantly improved after administration of nurse-initiated corticosteroids and beta-agonist. Two studies reported significant reduction in Emergency Department length of stay when nurse-initiated interventions were introduced. Hospital admission rates were lower in nurse-initiated groups (OR 0.51, CI: 0.40, 0.66). Three studies reported significantly increased satisfaction when patients received nurse-initiated interventions.
Conclusions: Nurse-initiated interventions in the Emergency Department are associated with improved time-to-treatment, pain and symptom relief, and reduced rates of hospital admission. Nurses, can safely and effectively provide early assessment and treatment of acute conditions in the emergency department. Implementation and adherence to nurse-initiated protocols was variable amongst the included studies. Rates of analgesia administration remained low despite the presence of treatment protocols. Variability in practice and the quasi-experimental and retrospective design of many of the studies also limits the strength of conclusions that can be drawn from this review. Further research is warranted specifically regarding standardizing nurse-initiated protocols and how to integrate these into the patients overall episode of care, understanding reasons for variability of implementation and adherence to nurse-initiated protocols.

An Emergency Department nurse who moonlights as a researcher. Or is it the other way round??