Cochrane review: Substitution of nurses for physicians in the hospital setting for patient, process of care, and economic outcomes

[Sly Saint]

Abstract​

available in

• English
• Español
• فارسی
• Français
• Português

Rationale​

The demand for health services to deliver hospital‐based care has increased due to an ageing population, more complex healthcare needs, comorbidities, and increasing healthcare costs. Nurse‐physician substitution can improve access to care for patients who may otherwise have a significant wait for review by a physician.

Objectives​

The main objective of this review was to examine the impact of substituting nurses for physicians in the hospital setting (hospital inpatient units and outpatient clinics) on patient outcomes, process of care outcomes, and economic outcomes.

The secondary objectives of this review were to assess whether the effects of nurse‐physician substitution differ according to healthcare setting (low‐ and middle‐income countries (which included low‐income, lower middle‐income, and upper middle‐income countries) versus high‐income countries), patient type, patient disease, intervention type (inpatient care, nurse‐led clinics, role substitution, and task substitution), nurse grade, additional training, level of responsibility, and mode of substitution for nurse‐led clinics (telephone/telehealth, partial substitution, enhanced substitution, and full substitution).

Search methods​

We searched CENTRAL, MEDLINE, Embase, NHSEED, CINAHL, ProQuest, two citation indexes, and two trial registries. We also conducted handsearches, reference checking, and contacted study authors to identify eligible studies. We searched five grey literature databases and contacted experts relevant to the review area. The evidence is current to 25 June 2024.

Eligibility criteria​

We included randomised controlled trials of both individual and cluster design that compared the effects of care delivered by a nurse to that delivered by a physician on patient, process of care, and economic outcomes. We included care of inpatients or outpatients in hospital settings.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013616.pub2/full

 

[MeSci]

I have generally found nurses to be much better at caring than doctors. They actually talk to you and listen to what you say. Not all, of course.