Triage nurse-initiated orders in pediatric emergency care: A single-center retrospective cohort study of appendix and testicular ultrasounds

Background

Triage nurse-initiated imaging orders (TNIO) are a promising strategy to improve emergency department (ED) efficiency and length of stay (LOS). However, limited data exists on the impact of TNIO ultrasounds in pediatric appendicitis and testicular torsion.

Objectives

This study aimed to measure the utilization of TNIO for appendix and testicular ultrasounds and evaluate their impact on LOS. Secondary objectives included assessing effects on time to pain interventions, time to antibiotics, return visits, departures prior to provider evaluation, and need for additional imaging.

Methods

A single center, retrospective cohort study of patients aged 0–21 years old presenting to a pediatric ED from 2018 and 2023 who underwent appendix or testicular ultrasounds. Patients bypassing triage or who had pre-triage ultrasound orders were excluded. Patients were grouped by nurse-initiated or provider-initiated ultrasounds. Statistical analyses included descriptive statistics and multivariate regression.

Results

Of 9594 appendix ultrasounds, 20.4 % were nurse-initiated, reducing LOS by 12.7 % (p < 0.001). Of 2525 testicular ultrasounds, 41.9 % were TNIO, reducing LOS by 6.4 % (p < 0.001). TNIO for appendicitis reduced time to antibiotics by 11.9 % (p < 0.001) but had no effect on time to pain control. TNIO patients had fewer return visits (p < 0.001) but higher rates of departures prior to provider evaluation (p < 0.001). Disparities were observed, with Non-Hispanic Black and Medicaid patients less likely to receive TNIO for appendicitis.

Conclusion

Triage nurse-initiated ultrasounds reduce LOS in cases of suspected appendicitis and testicular torsion. Implementing triage nurse-initiated imaging protocols could potentially optimize the care of pediatric patients with these conditions, ultimately improving ED efficiency.