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

Predicted nurse shortages internationally call for nurses to work at their full scope of practice. Nurse practitioners recommending computerised tomography imaging require medical signoff impacting emergency department flow. We aimed to develop a clinical guideline to support nurse practitioner-led requesting of computerised tomography scans for adults presenting to emergency department ambulatory care at a regional hospital.

We used a RAND/UCLA appropriateness method over two phases. Literature from a detailed review using a systematic process was extracted and synthesized into categories and shared via an online survey platform for phase one. Aggregated votes and comments were re-shared in summary before phase two, a face-to-face meeting of expert stakeholders.

Five experts anonymously participated in phase one, and six contributed to the phase two meeting. Phase one agreement on appropriateness on the three literature generated topics ranged between 60 % and 80 %. Concerns about the need for emergency departments to be strategic with resources and fears of risk of increase in radiation exposure to patients were raised. In phase two, seven of the proposed eight items reached consensus (83 %-100 %).

The agreed guideline supporting nurse practitioner ordering of computerised tomography scans provides a pathway to improve ambulatory care flow for patients with specific conditions.