Burdened with waiting: guideline development supporting nurse
practitioners to streamline patient flow.
Peet J1,2, Watts S2, Cowen A2, Charters D2, Craswell A1,2,3
1University Of The Sunshine Coast, 2Metro North Hospital and Health Service-Caboolture, Kilcoy,
Woodford Hospitals., 3Sunshine Coast Health Institute
Background:
Hospitals and emergency departments (ED) are grappling with major patient flow issues. Nurse
Practitioners (NP) are an existing resource with advanced assessment skills that could be utilised
further to support patient flow, reduce wait times and improve patient experience. Increasing NPs
scope from prescribing general radiology to include Computerised Tomography (CT) scans could
maximise their impact.
Objective:
To develop a clinical guideline through expert consensus and best evidence to support NP-led
prescribing of CT scans for adults seen in ED ambulatory care-like environments in a regional hospital.
Methods:
We used a consensus study design, guided by the Rand-UCLA appropriateness method (RAM), to
reach stakeholder agreement on expanding the NP role through development of a clinical guideline.
Phase 1 was a detailed evidence review, synthesis and summary of the literature, which was shared
electronically with all stakeholders for voting and comment. A face-to-face consensus meeting (phase
2) enabled the expert panel to voice concerns, explore areas of agreement and divergence, clarify
safety nets and receive guidance from the hospital quality and safety representative. The panel
anonymously re-rated appropriateness for each section of the guideline through a simple voting
system.
Results:
In phase 1, five experts anonymously participated in reviewing the current evidence summary.
Despite limited available research and low-quality evidence, agreement on appropriateness for the
three topics identified ranged between 60%-80% with experts supporting the development of a
guideline. Six experts joined phase 2. Conversations around potential increase in resource use and
radiation exposure where facilitated. Consensus was reached in seven of the eight items proposed in
the guideline (83%-100%).
Conclusion:
Clinicians work in dynamic and busy environments. Working to full scope of practice can reduce
inefficiencies and improve safe patient care through use of an expert developed clinical guideline.