Nurse practitioner management of common respiratory and genitourinary infections, using protocols

Included in this study were all patients with symptoms of respiratory tract infection and female patients with symptoms of urinary tract and vaginal infections who sought care from a hospital-based outpatient department walk-in unit which was operated in two different modes: experimental (the "nurse-protocol mode")-in which a nurse practitioner guided by a protocol initially evaluated all such patients and independently managed many patients- and traditional-in which only physicians managed patients. Safety, effectiveness, efficiency, and cost of care rendered for these tracer conditions in the two modes were compared. No serious illnesses were overlooked by practitioners in either mode. Eighty-six percent of patients in the nurse-protocol mode and 73 percent of patients in the traditional mode reported good symptom relief. Patients reported equivalent satisfaction with care. The time physicians spent managing patients with these complaints was reduced by 91 percent from 15.5 minutes to 1.4 minutes per patient. Personnel costs were equivalent in the two modes. Costs of laboratory tests and medications ordered were 27 percent less in the nurse-protocol mode. The study indicated that care in the nurse-protocol mode was of equivalent quality, led to equivalent patient satisfaction, allowed a substantial reduction in physician time, and reduced overall costs of care.