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Randomised controlled trial
Simple variations to traditional models of care can dramatically improve emergency department performance
  1. Gerard O'Reilly
  1. School of Public Health and Preventive Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia
  1. Correspondence to Dr Gerard O'Reilly, School of Public Health and Preventive Medicine, Monash University, Commercial Road, Melbourne, Victoria 3004, Australia; gerard.oreilly{at}

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Commentary on: Douma MJ, Drake CA, O’Dochartaigh DA, et al. Pragmatic randomized evaluation of a nurse-initiated protocol to improve timeliness of care in an urban emergency department. Ann Emerg Med 2016;68:546–52.

Implications for practice and research

  • Implementing a system of nurse-led care, using clinical protocols based on a patient’s presenting complaint, can lead to an improvement in emergency department performance.

  • Pragmatic randomised controlled trials are a valid and feasible research methodology for evaluating the impact of nurse-delivered protocols on the quality of care in the emergency department.


Overcrowding is a common problem in emergency departments globally. A lack of patient flow through the emergency department can have detrimental impacts on patient experience and outcomes. Multiple interventions have been tried in an effort to improve key process indicators, including a reduction in time to be seen, time to investigations and treatment, and emergency department length of stay. Most of these interventions have been delivered along traditional medical and nursing roles, …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.