Date of Conferral

2020

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Anna Valdez

Abstract

Long wait times in emergency departments across the United States contribute to overcrowding, and adverse patient outcomes. Adult emergency departments use nurse-driven protocols to decrease time to treatment and wait times. However, nurse-driven protocols are not commonly used in the pediatric emergency department (ED). The purpose of this project was to evaluate and appraise current evidence to determine if nurse-driven protocols can be safely implemented to improve ED wait times, time to disposition, patient/family satisfaction, and patient outcomes in the pediatric emergency setting. The Iowa model of evidence-based practice (EBP) was used to guide the mixed methods systematic review. A comprehensive review of the literature was completed using CINAHL, Medline full text, Cochrane Review, Joanna Briggs, PubMed, and other relevant databases. Peer reviewed studies published in English between 2010 and 2020 that addressed nurse-driven pediatric protocols were included in this review. A total of 55 articles were identified and 8 met the inclusion criterion. Included studies were appraised for level of evidence using the Fineout-Overholt and Melnyk method and quality using the Iowa model of EBP. Most studies were appraised at level IV with a quality of B indicating that stronger evidence is needed. Although existing evidence supported decreased time to treatment and length of stay (LOS), more studies are needed to determine the safety and efficacy of nurse-driven protocols in the pediatric emergency setting. The findings of this mixed method systematic review can be used to promote positive social change by guiding future research and implementation of nurse-driven protocols in pediatric emergency settings.

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