Nurse-Driven Protocols for Abdominal Pain in the Emergency Department

Abstract

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation. PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 weeks? Evidence: Fourteen studies were identified and supported evidence of effective NDP use for reducing the LOS and LWBS rate amongst abdominal pain patients. Improved clinical outcomes, enhanced operational efficiencies, increased patient and staff satisfaction, and NDP utility in multiple disease states were themes recognized in the literature. Intervention: The evidence-based NDP empowered ED nurses to obtain laboratory diagnostic data and implement nursing interventions within a facility-approved protocol designed to improve throughput by decreasing the time from patient presentation to obtaining medical disposition. Outcome: A pre and post-implementation design found a clinically significant mean reduction of 28-minutes in LOS with the use of the NDP. Overall LWBS was reduced from 5.2 to 2.3 percent and found to be statistically significant. Conclusion: Implementation of an ED abdominal pain NDP was effective in decreasing ED LOS and LWBS. Emergency nurses reported a sense of empowerment with the use of the NDP.