Objective: to identify patient groups within Accident and Emergency (A & E) practice where the nurse practitioner, following agreed protocols and treatment regimes, might make a contribution to patient care; and to describe a possible process of preparation required to introduce nurse practitioners into an A & E department.
Design: A 14-day study (6-12 January and 24-30 July 1994) in which the case notes of all patients attending the A & E department were analysed.
Setting: The A & E department of Aberdeen Royal Infirmary, UK.
Participants: A census of the case notes of 1785 patients.
Main outcome measures: Demographic and clinical characteristics of new patients, diagnosis, investigations, treatment ordered, numbers of return visits, source of referrals and disposal destinations.
Results: On analyses of the workload profile it became apparent that a small number of injury categories, investigations and treatments, accounted for a significant percentage of patient throughput and that 75% of cases attended between 09:00 and 21:00 h. Many cases were of a minor nature, discharged home after minimal treatment and no follow-up. It was thought possible that the assessment and treatment of a significant percentage of patients (30%) could be carried out by suitably trained and experienced nurses working to an agreed protocol.
Conclusions: The paper discusses the concept of the nurse practitioner and seeks to demonstrate a possible role for such a clinical worker using previously agreed protocols devised from a clinical database of patient requirements. Their employment could possibly bring a considerable routine saving in waiting time for patients with minor injuries.