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Three Part Question

In [patients with minor injuries within a UK ED] does [a nurse practitioner or junior doctor] result in [better patient satisfaction]?

Clinical Scenario

Your Directorate Manager wishes to introduce an Emergency Nurse Practitioner service to your ED. A colleague asks if you think patients coming to the ED with minor injuries would be willing to be seen by a nurse rather than a doctor.

Search Strategy

Medline 1966-04 using the OVID interface
[{exp nurse practitioner/ OR nurse practit$.mp. OR exp nurse clinician/ OR nurse clinicia$.mp} AND {exp patient satisfaction/ OR satisf$.mp}]

Search Outcome

213 papers of which 3 were relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Byrne et al 2000 UK	163 patients in an A&E, a Minor accident treatment service (MATS) unit and a nurse-led minor injuries unit. Age >16 years, minor injuries	Cross sectional survey	Patient satisfaction, waiting times, length of consultations and waiting for services	89.3% satisfaction ENP in MATS, 85.7% satisfaction in MIU. 70.7% in A&E by SHO. Significant 0.05 level.	Small numbers and compression of groups. Use of MIU in calculations. Long period of 8 months. No randomisation.
Sakr et al 1999 UK	1453 patients age > 16 years with minor injuries	RCT	Patient satisfaction, clinical errors, documentation, accuracy of treatment, follow-up	96.5% satisfaction ENP. 94.9% satisfaction SHO. No significant differences.	All patients seen by 1 or 2 registrars as gold standard, ? bias. 56.5 and 57.8% response rate of questionnaires.
Cooper et al 2002 UK	199 convenience sample, aged > 16 years with specific minor injuries. Comparing ENP to SHO.	RCT	Satisfaction, returns, quality of documentation etc	98.8% satisfaction ENP. 87.7% satisfaction SHO p<0.001	Non responders of self-completed questionnaire, ?bias only when ENP and researcher on duty

Comment(s)

Difficult to assess satisfaction accurately

Clinical Bottom Line

Patients are just as satisfied, if not more so, with seeing a Nurse Practitioner rather than a junior doctor in an ED. This does not mean that they receive better care and a robust reproducible method of assessing this needs to be devised.

References

1. Byrne G. Richardson M. Brunsdon J. Patel A. An evaluation of the care of patients with minor injuries in emergency settings. Accident & Emergency Nursing. 8(2):101-9, 2000 Apr.
2. Sakr M. Angus J. Perrin J. Nixon C. Nicholl J. Wardrope J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Lancet. 354(9187):1321-6, 1999 Oct 16.
3. Cooper MA. Lindsay GM. Kinn S. Swann IJ. Evaluating Emergency Nurse Practitioner services: a randomized controlled trial. Journal of Advanced Nursing 40(6):721-30, 2002 Dec.