Cost-effectiveness of the SEN-concept: Specialized Emergency Nurses (SEN) treating ankle/foot injuries

BMC Musculoskelet Disord. 2007 Oct 1;8:99. doi: 10.1186/1471-2474-8-99.


Background: Emergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol.

Methods: An economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle and foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups with the difference in sensitivity and specificity between groups in diagnosing fractures and severe sprains. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane.

Results: No significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were euro 186 (SD euro 623) for patients in the SEN group and euro 153 (SD euro 529) for patients in the HO group. The difference in total costs was euro 33 (95% CI: - euro 84 to euro 155). The incremental cost-effectiveness ratio was euro 27 for a reduction of one missed diagnosis and euro 18 for a reduction of one false negative.

Conclusion: Considering the benefits of the SEN-concept in terms of decreased workload for the ED physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED crowding.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Ankle Injuries / diagnosis
  • Ankle Injuries / economics*
  • Ankle Injuries / nursing
  • Cost-Benefit Analysis
  • Emergency Nursing / economics
  • Emergency Nursing / organization & administration*
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Foot Injuries / diagnosis
  • Foot Injuries / economics*
  • Foot Injuries / nursing
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Medical Staff, Hospital / economics*
  • Medical Staff, Hospital / statistics & numerical data
  • Middle Aged
  • Nursing Service, Hospital / economics*
  • Nursing Service, Hospital / statistics & numerical data
  • Treatment Outcome
  • Workload / statistics & numerical data