Protocol for nurse led pathology in an urban Emergency Department- blood + protocol initiating nurses (b+pin)

Natasha Jennings1, Katie Murdoch1, Dr Mike Noonan1, Charlotte Stevens1, Mark Marquez1, Kelly Decker1

1The Alfred, Little River, Australia

AIM: The aim of a nurse led protocol is to improve our delivery of timely quality care to our ED patients by:

  • Expediting pathology collection and analysis as an aide early clinical decision making
  • Targeting education aimed at rational investigation selection
  • Reducing the incidence of mismatched pathology specimens

Using a pre-defined protocol, Blood+Protocol Initiating Nurses (B-PIN) will be able to electronically order pathology investigations prior to the patient being assessed by a medical officer or nurse practitioner.

BACKGROUND: Nurse initiated pathology has shown to have decreased waiting times and length of stay for ED patients, improved patient satisfaction, reduced inappropriate test ordering and reduced pathology order/ mismatch. Delay in the collection of samples or inaccuracy during collection can impact patient flow and quality of care. The wide variation in test-ordering, particularly when tests are used for diagnostic purposes, suggest that some tests are unnecessary or ordered inappropriately. As investigations account for a significant proportion of total healthcare costs, unnecessary tests are also a waste of resources and an excessive cost to the health service.

DISCUSSION: Nurse-initiated pathology protocols are not a new innovation to the ED. Until the introduction of the B+PIN in March 2017, solely medical officers or nurse practitioners had undertaken pathology ordering. The implementation of a nurse initiated pathology protocol required a rigorous education plan and assessment to ensure that safe and efficient ordering and collection of pathology occurred. Key stakeholder engagement, working party involvement, education program development, online training and the credentialing assessments will be detailed.

CONCLUSIONS:  Emergency nurse led protocols have been shown to improve patient clinical outcomes. The B+PIN expansion for current registered nurses will empower them to be able to offer improved timeliness of pathology collection, make clinical decisions more efficient and may reduce mismatching of specimens.


Tash is an emergency nurse practitioner with a focus on advancing nursing practice.