Nurse practitioners may help reduce wait times without impairing quality of care. Ninety-six percent of patients with back problems were satisfied with the assessment carried out by a specially trained nurse practitioner, according to a study in the December issue of the Journal of Advanced Nursing.
Moreover, the NP came up with exactly the same clinical diagnosis as two orthopedic spine surgeons in all 177 patients she assessed. She also suggested the same management plan as the two surgeons in 95% of cases.
"Nurse practitioners can play an effective and efficient role in delivering care to patients requiring specific disease management in a specialty setting. Although the required skill set in assessing these patients may vary from NP to NP, collaboration and support from the physician can help to develop expertise in a specialty area," the paper concludes.
The aim of the year-long pilot study, conducted Toronto Western Hospital in Ontario, was to determine whether a clinic led by a nurse practitioner could speed up the diagnosis and management of patients with certain spinal conditions. (Most patients seen by spine surgeons are not surgical candidates, the researchers note; their treatment plan usually consists of education, and non-invasive therapies to help manage their conditions.)
The 96 male and 81 female patients with suspected disc herniation, spinal stenosis, or degenerative disc disease had been referred by their family doctors.
Just under 10% were correctly identified as surgical candidates by the nurse practitioner. In addition, 66 were referred for specific nerve root block, 14 for facet block, and 26 for further radiological imaging.
Overallsatisfaction was very high (96%), and 91% of patients reported that they understood their condition better after seeing the nurse practitioner.
Patients waited10 to 21 weeks to see the NP, with an average wait of 12 weeks. This compared with 10 to 52 weeks to be seen by the surgeons in a conventional clinic, with average waiting times ranging from three to four months for disc herniations to eight to 12 months for spinal stenosis.
Seventy-four percent of the patients were happy to see the NP rather than wait up to a year to see a surgeon. Twenty-six percent said they would have preferred to have been seen by a surgeon in a conventional clinic, but of those, 77% said they would not have been prepared to wait an extra three to four months to do so.
Clinical, legal, and funding barriers in the Canadian health system prevent nurse practitioners from being fully independent when it comes to assessing and managing patients who require specialist care, notes nurse practitioner Angela Sarro, the nurse practitionerand a study co-author. She sees the potential for government-funded triage clinics led by NPs to reduce waiting times for spine consultations.
The findings have implications beyond back issues, she adds. "I feel the findings can be applied to various specialties in which the nurse practitioner has the knowledge and expertise to assess, diagnose, and recommend a plan of care for patients," Sarro tells HealthLeaders Media. "Wait times in other specialties can be long, and with more timely access to care, patients can be informed of their condition, and be provided with education and knowledge to help improve health outcomes."
In fact, Toronto Western Hospital is now assessing the potential to expand the practice of nurse practitioners being the point of contact for ongoing care of patients with a variety of conditions.
Whether the approach could be implemented in the United States or elsewhere, says Sarro, "would depend on the scope of practice that is allotted to nurse practitioners in that country based on legislation."