This retrospective study compared the number of missed injuries and inappropriately managed cases treated by emergency NPs (ENPs) with those treated by junior doctors/senior house officers at a Netherlands hospital. Van der Linden and colleagues defined missed injuries as those that could have been diagnosed during an ED visit but weren't and inappropriately managed cases as those in which ED protocol wasn't followed and no justification was provided. Missed injuries were measured on a severity scale of 1 to 7, with 7 being the most severe.

A total of 741 patients who required a low level of care and were treated by a registered ENP were included in the study. These were matched by date of care with a random sample of 741 patients who were seen by junior doctors/senior house officers.

Overall, there were 17 missed injuries, five by a junior doctor/senior house officer and 12 by an ENP. Of 12 inappropriately managed cases, four were seen by a junior doctor/senior house officer and eight by an ENP. The numbers of missed injuries or inappropriately managed cases weren't significantly different between the ENP and physician groups. In addition, the median severity score for missed injuries was 2 in both groups. The primary reason for missed injuries, accounting for 13 of 17 cases, was misinterpretation of X-rays.

Waiting time was comparable for patients seen by either health care provider; however, mean length of stay was shorter for those seen by ENPs (65 minutes) than for those seen by junior doctors/senior house officers (85 minutes).