Efficacy of nurse practitioner management of primary care emergency visits

Objective: To assess the efficacy of nurse practitioner management of emergency visits by means of consensus protocols integrated into the computerized medical record system of a primary health care center. Methods: Descriptive, cross-sectional, retrospective study. All patients seeking appointments for same-day care within a semiurban health care district in the province of Girona, Spain, were included consecutively between March 15 and April 15, 2010. We evaluated the nurses' application of the appropriate computerized practice protocols in the system. Sociodemographic variables (age, sex, country of origin), care variables (reason for the visit), and nurse variables (seniority, place of work) were analyzed. The nurses' efficacy was evaluated on the basis of revisits within 48 hours or the need for referral to another care provider. Results: A total of 296 visits were included. The mean (SD) patient age was 34.4 (25.5) years; 53.3% were women and 25.3% were immigrants. Open wounds (12.5%) were the main reason for seeking care. No revisits within 48 hours were needed in 77.4% of the cases (80.5% of those treated by protocol did not revisit vs 73.2% of those whose care was not protocol-guided, P=.14). Conditions treated by protocol (57.1% of the visits) generated fewer referrals to another professional (33.1% of protocol-guided visits were referred vs 64.6% of nonprotocol-guided visits, P<.001). Immigrants made fewer revisits for problems treated by protocol (12.1% revisited vs 29.4% when no protocol was used, P=.04). Younger patients revisited less often (mean age of 31.5 [24] years for patients not revisiting vs 41.1 [25] years for revisitors, P=.04). Conclusions: The ability of the nursing staff to manage primary care emergency visits is high. Nurse practitioner efficacy increases when a computerized protocol is available to assist in managing a case.