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Developing a clinical guideline supporting nurse practitioner requesting computerized tomography scans via consensus

Alison Craswell1, Jacqueline Peet2, Aletta Cowen3

  • 1University of Sunshine Coast (UniSC), School of Health, Sippy Downs, QLD, Australia; Sunshine Coast Health Institute, QLD, Australia; Metro North Hospital and Health Service-Caboolture, Woodford Hospitals, Kilcoy, QLD, Australia.

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Summary

A new guideline allows nurse practitioners to order computerized tomography (CT) scans for adults in emergency departments. This supports nurses working at their full scope of practice and improves patient flow.

Keywords:
Ambulatory careComputerized tomography (CT) scanConsensus methodEmergency departmentFast trackNurse practitionerRadiology/imagingScope of practice

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Area of Science:

  • Nursing Practice
  • Radiology
  • Healthcare Management

Background:

  • International nurse shortages necessitate full scope of practice utilization.
  • Current nurse practitioner (NP) roles in ordering computerized tomography (CT) scans require physician oversight, impacting emergency department (ED) efficiency.
  • A clinical guideline was developed to support NP-led CT scan requests in ED ambulatory care.

Purpose of the Study:

  • To develop a clinical guideline for nurse practitioners requesting computerized tomography (CT) scans.
  • To improve the efficiency of emergency department (ED) ambulatory care.
  • To support nurses working at their full scope of practice.

Main Methods:

  • A two-phase RAND/UCLA appropriateness method was employed.
  • Systematic literature review and synthesis into categories for expert review.
  • Online survey for phase one and a face-to-face meeting for phase two with expert stakeholders.

Main Results:

  • Phase one showed 60%-80% agreement on appropriateness, with concerns regarding resource allocation and radiation exposure.
  • Phase two achieved 83%-100% consensus on seven of eight proposed guideline items.
  • Five experts participated in phase one, and six in phase two.

Conclusions:

  • An agreed guideline supports nurse practitioner (NP) ordering of computerized tomography (CT) scans.
  • The guideline aims to enhance ambulatory care flow for specific patient conditions.
  • This initiative supports NPs in practicing to their full scope.