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BACKGROUND: Emergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED-physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short injury-specific course, were trained to assess and treat minor injuries according to a specific protocol.
METHODS: An economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle/foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups to the difference in sensitivity and specificity. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane.
RESULTS: No significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were E 186 (SD E 623) for patients in the SEN group and E 153 (SD E 529) for patients in the HO group. The difference in total costs was E 33 (95% CI: - E 84 to E 155). The incremental cost-effectiveness ratio was E 27 for a reduction of one missed diagnosis and E 18 for a reduction of one false negative.
CONCLUSION: Considering the benefits of the SEN-concept in terms of decreased workload for the ED-physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED-crowding.
Emergency nurses treating foot and ankle conditions
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