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15-11-2012 | Legal medicine | Article

'Extended-skill' nurses, physiotherapists are as effective as the ER doc


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medwireNews: Patients with peripheral soft tissue injuries achieve similar clinical outcomes when treated by emergency nurse practitioners (ENPs) and extended-scope physiotherapists (ESPs) in the emergency department, as when they are treated by doctors, show UK study results.

The findings support the emergence of ENPs as an integral part of minor injuries care, and indicate that ESPs should also be considered part of the "clinical skill mix," say Carey Middleton McClellan (University Hospitals Bristol NHS [National Health Service] Foundation Trust) and co-investigators.

"As all groups were found to be clinically equivalent it is other factors such as cost, workforce sustainability, service provision and skill mix that become important," they remark in BMJ Open.

The team randomly assigned 372 patients attending an inner-city emergency department between October 2006 and December 2007 with a peripheral soft tissue injury, defined as a traumatic peripheral musculoskeletal injury less than 72 hours old with no associated bone fracture, ongoing prior injury, or systemic disease or disorder.

A total of 126 patients were assigned to be seen by an ESP, 123 by an ENP, and 123 by a doctor.

At 8 weeks postinjury, the functional recovery outcomes - assessed using the Disability of the Arm, Shoulder, and Hand score, and Lower Extremity Functional Score, as relevant - were equivalent in patients treated by ESPs and ENPs to those treated by doctors, at 63.3%, 59.2%, and 60.0%, respectively.

However, outcomes at 2 weeks postinjury were "less clear cut," remark Middleton McClellan and colleagues who found no significant differences in self-reported recovery between treatment groups at either time point.

The researchers report that doctors and ENPs spent a similar amount of time in consultation per patient, with the majority of consultations completed within 0-10 minutes for both groups, while the majority of ESP-treated patients had consultations lasting between 10 and 25 minutes.

The ESPs also administered medication to significantly fewer patients than did the ENPs and doctors, at 3.6% versus 23.2% and 42.2%, respectively.

"Nurses and allied health professionals are increasingly adopting new roles within the NHS in the four nations of the UK, adapting previous skills and utilising proactive education programmes to expand their scope of practice," explain the authors, who suggest that confirmation of their findings in additional settings would be valuable.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Sarah Guy, medwireNews Reporter

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