Practice Improvement| Volume 44, ISSUE 3, P236-241, May 2018

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Evaluation of an Evidence-Based Throat-Pain Protocol to Reduce Left-Without-Being-Seen, Length of Stay, and Antibiotic Prescribing

Published:September 21, 2017DOI:



      Increasing numbers of people are seeking unscheduled medical care in United States’ emergency departments, which contributes to delayed throughput and increased patient length of stay. Implementation of nurse-initiated protocols, such as those for throat pain, initiates early diagnostic testing, optimizes patient throughput strategies, and promotes adherence to clinic practice guidelines for an additional segment of patients.


      To evaluate the effect of an evidence-based throat-pain protocol.


      The medical records for 117 patients presenting with throat pain to the emergency department were reviewed and separated into 3 groups: no testing, medical provider–initiated testing, or nurse-initiated testing using the protocol. Main outcome variables were number of patients that left without being seen (LWBS), patient length of stay, and antibiotic prescribing.


      No patients LWBS from the nurse-initiated testing group or no-testing group compared with 3% from the medical provider–initiated group. By eliminating these LWBS patients, there is a potential cost savings of $3,420 over a 12-month period. The overall mean length of stay was 6 minutes shorter in the nurse-initiated group than the other 2 groups evaluated. Antibiotic prescriptions were given for 48% of patients in the protocol group compared with 52% in the medical provider group and 70% in the no-testing group.


      Although this department has only partially implemented a protocol for throat pain, it highlights the benefits to reduce the number of patients that LWBS and reduce patient length of stay. The use of the protocol also improved adherence to clinical practice guidelines for testing and antibiotic prescribing.
      Contribution to Emergency Nursing Practice
      • With increasing wait times across the country, it is important to consider all time-saving strategies to improve ED throughput, such as a nurse-initiated throat-pain protocol.
      • Adoption of practices that support diagnostics testing early in the patient visit decreases the number of patients who leave without being seen.
      • Nursing application of a throat-pain protocol increases adherence to clinical practice guidelines and improves antibiotic stewardship.

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      Deanna Settelmeyer, Member, Mr. Jefferson’s ENA, is Doctor of Nursing Practice candidate at University of Virginia School of Nursing, Charlottesville, VA.