Care of minor injuries by emergency nurse practitioners or junior doctors:a randomised controlled trial

Background We aimed to assess the care and outcome of patients with minor i njuries who were managed by a nurse practitioner or a junior doctor in our accident and emergency department. Methods 1453 eligible patients, over age 16 years, who presented at our dep artment with minor injuries were randomly assigned care by a nurse practiti oner (n=704) or by a junior doctor (n=749). Each patient was first assessed by the nurse practitioner or junior doctor who did a clinical assessment; the assessments were transcribed afterwards to maintain masked conditions. Patients were then assessed by an experienced accident and emergency physic ian (research registrar) who completed a research assessment, but took no p art in the clinical management of the patient. A standard form was used to compare the clinical assessment of the nurse practitioner or junior doctor with the assessment of the research registrar. The primary outcome measure was the adequacy of care (history taking, examination of patient, interpret ation of radiographs, treatment decision, advice, and follow-up). Findings Compared with the rigorous standard of the experienced accident an d emergency research registrar, nurse practitioners and junior doctors made clinically important errors in 65 (9.2%) of 704 patients and in 80 (10.7%) of 749 patients, respectively. This difference was not significant. The nu rse practitioners were better than junior doctors at recording medical hist ory and fewer patients seen by a nurse practitioner had to seek unplanned f ollow-up advice about their injury. There were no significant differences b etween nurse practitioners and junior doctors in the accuracy of examinatio n, adequacy of treatment, planned follow-up, or requests for radiography, Interpretation of radiographs was similar in the two groups. Interpretation Properly trained accident and emergency nurse practitioners, who work with in agreed guidelines can provide care for patients with minor injuries that is equal or in some ways better than that provided by junior doctors.