Diagnostic accuracy of emergency nurse practitioners versus physicians related to minor illnesses and injuries.
BACKGROUND
Our objectives were to determine the incidence of missed injuries and inappropriately managed cases in patients with minor injuries and illnesses and to evaluate diagnostic accuracy of the emergency nurse practitioners (ENPs) compared with junior doctors/senior house officers (SHOs).


METHODS
In a descriptive cohort study, 741 patients treated by ENPs were compared with a random sample of 741 patients treated by junior doctors/SHOs. Groups were compared regarding incidence and severity of missed injuries and inappropriately managed cases, waiting times, and length of stay.


RESULTS
Within the total group, 29 of the 1,482 patients (1.9%) had a missed injury or were inappropriately managed. No statistically significant difference was found between the ENP and physician groups in terms of missed injuries or inappropriate management, with 9 errors (1.2%) by junior doctors/SHOs and 20 errors (2.7%) by ENPs. The most common reason for missed injuries was misinterpretation of radiographs (13 of 17 missed injuries). There was no significant difference in waiting time for treatment by junior doctors/SHOs versus ENPs (20 minutes vs 19 minutes). The mean length of stay was significantly longer for junior doctors/SHOs (65 minutes for ENPs and 85 minutes for junior doctors/SHOs; P < .001; 95% confidence interval, 72.32-77.41).


CONCLUSIONS
ENPs showed high diagnostic accuracy, with 97.3% of the patients being correctly diagnosed and managed. No significant differences between nurse practitioners and physicians related to missed injuries and inappropriate management were detected.
van der Linden
Christien
C
Accident and Emergency Department, Medical Center Haaglanden,, The Hague, The Netherlands. chris10vanderlinden@hotmail.com
Reijnen
Resi
R
de Vos
Rien
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007223:Infant; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009722:Nurse Practitioners; D010820:Physicians; D011030:Pneumothorax / Q000175:diagnosis; D012189:Retrospective Studies; D055815:Young Adult