Nurse-Practitioner-Led Spinal Clinic May Be Effective, Feasible

Laurie Barclay, MD

November 19, 2010

November 19, 2010 — A nurse practitioner–led surgical spine consultation clinic may be effective and feasible, according to the results of a study reported in the November issue of the Journal of Advanced Nursing.

"Waiting times for specialty consultations in public healthcare systems worldwide are lengthy and impose undue stress on patients waiting for further information and management of their condition," lead author Angela Sarro, from Toronto Western Hospital in Ontario, Canada, said in a news release. "Back pain can be very unpleasant and debilitating and 85[%] of us will experience it at some point in our lives.... The aim of our study was to see whether a clinic led by a nurse practitioner could speed up the diagnosis and management of patients with certain spinal conditions pre-selected by the surgeons' offices."

Another goal of this prospective study was to determine patient satisfaction and clinical accuracy with nonsurgical nurse practitioner management of preselected spinal referrals.

At a nurse practitioner–led spine consultation ambulatory clinic within a Canadian neuroscience center, all preselected patients evaluated by the nurse practitioner in 2008 completed a postconsultation validated patient satisfaction questionnaire. The surgeon reviewed all 177 patients to confirm or modify diagnosis and management. Conditions included disc herniations, spinal stenosis, and degenerative disc disease.

Mean time from referral to clinic evaluation was 12 weeks (range, 9.8 - 21 weeks) for the nurse practitioner–led clinic compared with 10 to 52 weeks for patients seen in a conventional clinic. The clinical diagnosis of the nurse practitioner agreed with that of the surgeon 100% of the time, and the management plan agreed in 95% of patients.

"We believe that our study demonstrates that nurse practitioners can play an effective and efficient role in delivering timely healthcare to patients requiring specific disease management in a specialty setting," said coauthor Yoga Raja Rampersaud, MD. "Although skill levels will vary from one nurse practitioner to another, physicians can work with them to help them to develop expertise in their specialty area. Ongoing evaluation is also important to ensure that quality of care is maintained and that patients are satisfied with the consultation."

The questionnaire revealed that 97% of patients were satisfied with the consultation, that 94% were pleased with examination thoroughness, and that only 26% preferred to wait longer for direct consultation with the surgeon.

Limitations of this study include the increasing length of time patients were waiting for a consultation — towards the end of the study, waiting times for the nurse practitioner were approaching those of the spine surgeon. Furthermore, patients needing additional follow-up for their spinal condition were seen directly by the spinal surgeon, whereas it would have been informative to give them a follow-up appointment with the nurse practitioner, followed by repeat administration of the satisfaction questionnaire.

"At the moment there are clinical, legal and funding barriers in the Canadian health system that prevent nurse practitioners from being fully independent when it comes to assessing and managing patients who require specialist care," Dr. Sarro concluded. "However, we feel that there may be scope for government-funded triage clinics led by nurse practitioners to reduce waiting times for spine consultations. This initiative would expand the role of the nurse practitioners and provide faster consultation and improved health outcomes for patients, families and communities."

The study authors have disclosed no relevant financial relationships.

J Advanced Nurs. 2010;66:2671-2676.


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