Two new reports demonstrate that in two different settings, care by NPs was safe and cost-effective while improving patients' access to care.

A review in Pediatric Emergency Care compared NPs and physicians administering procedural sedation and analgesia in one pediatric ED over a three-year period. Patients cared for by NPs waited less time from evaluation until sedation and had a shorter stay than patients under physicians' care: the time from admission to discharge was an average of 31 minutes shorter for patients managed by NPs.

NPs were more likely than physicians to use ketamine. It has a shorter recovery time than the fentanyl or morphine, which physicians used more frequently. NPs were also more likely to use adjunctive local anesthesia, which may have decreased the time required for sedation. There were no reports of severe airway complications whether patients were treated by NPs or physicians.

Another report published in Medical Care reviewed one year of patient claims in the state worker compensation program in Washington. Fewer injured workers cared for by NPs lost enough time from work to be compensated&-four or more days&-but the overall time lost was not significantly different whether the primary care provider was an NP or a physician. Disability outcomes for workers cared for by NPs and physicians were similar, and all significant differences in lost time favored NPs. Moreover, NPs improved access to care for injured workers living in rural areas and in counties with high unemployment rates. The authors suggest that NP care in compensation programs is cost-effective because NPs cost less to educate than physicians and are sometimes reimbursed at lower rates. (Total costs for injured workers were not significantly different whether the provider was an NP or a physician.)

Fran Mennick, BSN, RN