Clinical decision support tools in A&E nursing: a preliminary study.
OBJECTIVE
This article describes how a large trust in the north east of England is in the process of developing a unique service for non-emergency patients in one of its main A&E departments. The Urgent Need Assessment Service (UNAS), co-located within the main A&E department, features the use of NHS Direct computerised algorithms to enable nurses to recommend the best treatment or course of action accurately and safely, for all patients attending the department who are categorised as blue or green status in accordance with the Manchester triage model of A&E assessment. The UNAS facility incorporates discretely staffed minor injuries and minor ailments services.


METHODS
UNAS assessment nurses are specially trained to use their A&E experience, together with the computer model, and to make an assessment in partnership with the patient, sharing information displayed on the computer screen and working together to reach a jointly agreed treatment plan or outcome. The UNAS pilot and evaluation commenced in September 1999 and results and outcomes are presented for the period from September 3 to December 31 2000.


RESULTS
Approximately 75 per cent of all A&E attenders are given blue or green status. UNAS has led to faster treatment and reduced waiting times for these people, increasing patient satisfaction while enabling the A&E department to concentrate its resources on treating more serious cases.


CONCLUSIONS
This pilot study has proved to be highly satisfactory to the majority of people who have been treated at UNAS. Those previously regarded as 'inappropriate attenders' might be better suited to treatment in a different department, separate from the traditional A&E department, with reduced waiting times, and under the care of specially trained nurses.
New
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Northumbria Healthcare NHS Trust.
D000465:Algorithms; D003661:Decision Support Techniques; D016529:Emergency Nursing / Q000379:methods*; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D009730:Nursing Assessment / Q000379:methods*; D015403:Nursing Evaluation Research; D010347:Patient Care Planning; D010358:Patient Participation; D017060:Patient Satisfaction; D010865:Pilot Projects; D013997:Time Factors; D014218:Triage / Q000379:methods*; D006113:United Kingdom; D014850:Waiting Lists