how to achieve patient-centered testing: role of the protocol nurse

Patient-centered cardiac testing is predicated on choosing the right test for the right patient. we studied the effects of changing from script-driven scheduling to nurse-driven protocoling of stress tests. a protocol nurse reviewed records before scheduling and communicated with patients and ordering providers if needed. we found that instituting nurse protocolling of all non-imaging (ett) and nuclear (mpi) stress tests (n = 3071) resulted in protocol changes in 37% of our patients, and reduced the proportion of tests that could not be performed as scheduled by 56% and cancelations by 71% (p < 0.001 for each). these changes were sustained over two successive 6-month periods following a baseline observation period of 6 months. for mpi, the most frequent nurse interventions were re-protocoling as stress-first mpi (12% of tests), changing test location for clinical reasons (13%), changing stress modality (7%), and care coordination (5%). changing from script-driven scheduling to protocol nursing contributed measurably to patient-centered testing.