Should nurses be allowed to request X-rays in an accident & emergency department?

Area of Science:

• Emergency Medicine
• Nursing Practice
• Radiology

Background:

• The traditional role of nurses in emergency departments (A&E) is being re-evaluated to improve efficiency.
• Assessing the extended role of nurses, specifically in diagnostic imaging requests, is crucial for modern healthcare.
• Patient wait times in A&E departments are a significant concern impacting patient satisfaction and resource allocation.

Purpose of the Study:

• To evaluate the extended role of A&E nurses in requesting X-rays before physician assessment.
• To determine the accuracy and efficiency of nurse-initiated X-ray requests.
• To assess the impact of nurse-led X-ray requests on patient wait times in the A&E department.

Main Methods:

• A prospective study conducted in November 1990 at St John's Hospital A&E Department.
• 579 randomly selected patients were triaged by A&E nurses.
• X-ray requests made by triage nurses were compared with subsequent physician assessments and established triage criteria.

Main Results:

• Approximately 75% of triaged patients had X-rays requested by the triage nurse.
• Less than 7% of nurse-requested X-rays were deemed unnecessary by the managing physician.
• Over 90% of patients who saw a doctor for an X-ray met the triage criteria, indicating missed opportunities for earlier requests.

Conclusions:

• A&E nurses demonstrated accuracy and efficiency in requesting X-rays.
• Nurse-initiated X-ray requests can significantly reduce patient time spent in the A&E department.
• Expanding the role of A&E nurses in diagnostic imaging improves patient throughput and resource utilization.