Research ArticleResearchWorkflowQuality Improvement

Pragmatic RCT of 1,475 emergency patients demonstrates physiotherapist-led care shortens ED stay by 1 hour with high cost-effectiveness for uncomplicated musculoskeletal cases

The Lancet (PubMed)Oct 3, 2026

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Brief summary

The RESHAP-ED multicenter randomized trial of 1,475 emergency department patients demonstrated that physiotherapist-led care shortened ED length of stay by 1.0 hour without compromising patient safety, achieving a 98.1% probability of cost-effectiveness.

What NurseJet pulled from the source

Severe emergency department overcrowding and prolonged length of stay threaten clinical safety and hospital throughput. The pragmatic, open-label RESHAP-ED randomized controlled trial evaluated an advanced physiotherapist-led model of care across five emergency departments in New South Wales, Australia. Adults presenting with uncomplicated musculoskeletal conditions—including soft-tissue injuries, neck and back pain, and closed fractures or dislocations not requiring surgical admission—were randomized 1:1 to physiotherapist-led care (n=737) or usual physician- or nurse practitioner-led care (n=738). The primary outcome, emergency department length of stay from arrival to departure, was analyzed via an intention-to-treat linear mixed-effects model. Mean length of stay was 2.4 hours in the physiotherapist group versus 3.4 hours in usual care, representing a statistically significant reduction of 1.0 hour (95% CI: -1.2 to -0.8 hours). Adverse events occurred in 6.6% (39/591) of physiotherapy patients versus 5.9% (33/555) of controls (p = 0.72). The intervention delivered mean direct savings of -$35.1 (95% CI: -69.0 to -1.7) per patient with a 98.1% probability of cost-effectiveness.

Why this matters for nurses

Triage and emergency nurses face persistent throughput bottlenecks when low-acuity musculoskeletal injuries occupy acute exam beds and consume extensive physician time. Validating an allied health primary-contact model demonstrates an effective interprofessional staffing innovation to decompress triage queues, improve ED turnaround times, and preserve nursing and medical bandwidth for high-acuity resuscitation.

Bedside takeaway

In the 1,475-patient RESHAP-ED trial, physiotherapist-led ED care for uncomplicated musculoskeletal injuries shortened stay by 1.0 hour (2.4 vs 3.4 h) with equivalent adverse events (6.6% vs 5.9%) and 98.1% cost-effectiveness.

Key takeaways

Pragmatic RCT across 5 emergency departments randomized 1,475 adult patients with uncomplicated musculoskeletal conditions.
Physiotherapist-led care reduced mean ED length of stay by 1.0 hour (2.4 h vs 3.4 h; 95% CI: -1.2 to -0.8 h).
Safety profile was equivalent, with adverse events in 6.6% of physiotherapy patients vs 5.9% in usual physician/NP care (p = 0.72).
Direct healthcare costs were reduced by -$35.1 per patient (95% CI: -69.0 to -1.7).
Economic modeling established a 98.1% probability of cost-effectiveness for the physiotherapist-led care pathway.

Practice implications

Collaborate with triage and fast-track team members to route qualifying, hemodynamically stable musculoskeletal injuries to allied health providers per institutional protocol; ensure thorough nursing documentation of pain assessments and neurovascular checks.

Limitations & cautions

Open-label pragmatic design conducted within the Australian healthcare system; limited to uncomplicated musculoskeletal conditions without surgical indications.
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Citations

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The Lancet (PubMed)

The Lancet (PubMed). Physiotherapist-led care for musculoskeletal conditions in the emergency department (RESHAP-ED): a randomised controlled trial with economic evaluation.

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https://pubmed.ncbi.nlm.nih.gov/42660158/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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International journal of nursing studies (PubMed)Oct 19, 2026Systematic Review

A systematic review and per-unit linear meta-analysis across 13 observational studies of 3,831,327 hospitalized adults found that each additional patient assigned per nurse was associated with a 5.7% increase in the odds of 30-day all-cause mortality.

Leadership Med-SurgAI summaryReview source

Systematic ReviewResearchStaffing & WellbeingPolicyAI summary · original source linked below

Nurse staffing ratios remain central to inpatient quality and nurse retention, yet prior meta-analyses relied largely on coarse categorical groupings rather than quantifying marginal mortality shifts per extra patient. In this systematic review and per-unit linear random-effects meta-analysis (PROSPERO CRD420261368891), researchers searched PubMed, Embase, CINAHL, and Web of Science through July 10, 2026, for observational studies of acute care adults reporting fully adjusted per-unit effect estimates. Thirteen low-risk-of-bias studies spanning 3,831,327 patients across 1,593 hospitals were synthesized using restricted maximum likelihood and Bayesian hierarchical modeling. Each additional patient per nurse was associated with higher odds of 30-day all-cause mortality (pooled odds ratio [OR] 1.057, 95% CI: 1.041–1.074; I² = 43.3%; 95% prediction interval: 1.018–1.098). Bayesian modeling yielded a 1.000 posterior probability of a positive association. Although small-study effects were detected (Egger test t = 4.33, p < 0.001), trim-and-fill adjustment maintained significance. Because all included data were observational, evidence certainty was rated very low under GRADE, indicating estimates serve as policy reference parameters rather than definitive causal proof.

Key takeaways

Meta-analysis synthesized 13 studies covering 3,831,327 hospitalized adults across 1,593 acute-care hospitals.
Each additional patient assigned per nurse was associated with a 5.7% increase in 30-day all-cause mortality (pooled OR 1.057, 95% CI: 1.041–1.074).
Bayesian hierarchical modeling confirmed a 1.000 posterior probability of an increased mortality association.
Results remained robust across alternative estimators, subgroup analyses, and trim-and-fill sensitivity models.
GRADE certainty was very low due to observational design, requiring careful use as staffing policy reference parameters rather than proven causality.

Why this matters on shift

Nurse managers, hospital administrators, and staffing committees frequently weigh shift staffing ratios against operational labor costs. Demonstrating that every incremental patient added to an acute-care nurse workload corresponds to a statistically consistent 5.7% increase in 30-day patient mortality provides essential empirical grounding for mandated safe staffing ratios, acuity-based assignment models, and retention investments.

Bedside takeaway

In a meta-analysis of 3.8M patients across 1,593 hospitals, each extra patient assigned per nurse was associated with 5.7% higher odds of 30-day mortality (pooled OR 1.057, 95% CI 1.041–1.074; GRADE very low).

Nursing implications

Advocate for workload rebalancing and acuity-based staffing when patient-to-nurse ratios escalate; document unassigned care tasks and missed nursing care during high-census shifts through institutional safety reporting systems.

Limitations & cautions

Observational study designs cannot establish direct causality; evidence certainty rated very low per GRADE; potential residual confounding from hospital-level resources and patient illness severity.
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Citations · exact source links

International journal of nursing studies (PubMed). Nurse staffing and 30-day mortality in hospitalised adults: A systematic review and meta-analysis of per-unit associations.

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International journal of nursing studies advances (PubMed)Oct 14, 2026Systematic Review

A systematic review of five randomized controlled trials in adult patients found that non-nebulized topical lidocaine provides strong evidence for pain reduction and moderate evidence for easing discomfort and cough during nasogastric tube insertion.

Med-Surg EmergencyAI summaryReview source

Systematic ReviewResearchMedication SafetyWorkflowAI summary · original source linked below

Nasogastric tube (NGT) insertion is one of the most common and distressing bedside nursing procedures, frequently triggering severe nasal pain, pharyngeal trauma, and reflexive gagging. This systematic review (PROSPERO CRD420251177888) searched MEDLINE, Cochrane Central, and CINAHL through October 28, 2025, to assess the efficacy and safety of non-nebulized topical anesthetics or lubricants during adult NGT placement. Five randomized controlled trials evaluating topical lidocaine in formulations including nasal sprays, drops, viscous gels, and atomized solutions versus placebo or routine water-soluble lubricant were included. Methodological quality was independently appraised using the 13-item JBI Critical Appraisal Checklist for RCTs. Despite variation in dosing and administration routes, all five trials reported consistent reductions in procedural pain and discomfort scores. Best-evidence synthesis demonstrated strong evidence supporting lidocaine for procedural pain reduction and moderate evidence for reducing discomfort and insertion-related cough. Topical administration was well tolerated across all trials without serious hemodynamic or local mucosal adverse events.

Key takeaways

Systematic review synthesized five randomized controlled trials assessing topical lidocaine during adult nasogastric tube placement.
All included trials reported significant reductions in procedural pain or discomfort compared to placebo or basic lubricant.
Best-evidence synthesis identified strong evidence for pain reduction and moderate evidence for discomfort and cough reduction.
Formulations evaluated included topical lidocaine sprays, drops, viscous gels, and atomized nasal preparations.
Topical lidocaine was well tolerated with no serious local mucosal, allergic, or systemic adverse events reported.

Why this matters on shift

Medical-surgical, emergency, and critical care nurses insert thousands of nasogastric tubes annually, yet topical analgesia is inconsistently utilized due to lack of standardized unit protocols or provider orders. Demonstrating strong clinical trial evidence that topical lidocaine substantially reduces pain and distressing gag reflexes gives bedside nurses clear justification to champion routine pre-procedural topical analgesia protocols.

Bedside takeaway

A systematic review of 5 RCTs found that topical lidocaine (spray, gel, or drops) during adult nasogastric tube insertion provides strong evidence for pain reduction and moderate evidence for reduced discomfort and coughing.

Nursing implications

Consider topical lidocaine spray or viscous gel per facility protocol prior to adult nasogastric tube placement; allow adequate mucosal contact time (typically 3–5 minutes) and explain each step to optimize patient comfort and cooperation.

Limitations & cautions

Heterogeneity in lidocaine formulations, dosing regimens, and delivery methods across the five RCTs; insufficient data to confirm whether lidocaine improves first-pass insertion success rates.
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Citations · exact source links

International journal of nursing studies advances (PubMed). Lidocaine for pain and discomfort relief during nasogastric tube insertion: A systematic review.

Open original sourceFull brief

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Journal of pediatric nursing (PubMed)Oct 23, 2026Research Article

A randomized controlled trial of 140 children aged 3–6 years in a pediatric emergency department found that using a dragon-themed nebulizer mask significantly decreased child fear scores (d = 3.05) and shortened treatment duration compared with standard clear masks.

Peds EmergencyAI summaryReview source

Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

Inhalation therapy is frequently administered for acute respiratory distress in emergency settings, yet standard plastic masks often provoke intense fear and noncooperation in young children, prolonging treatment. In this parallel-group randomized controlled trial conducted between January and March 2026 at a tertiary pediatric emergency department in Istanbul (NCT06568120), 140 preschool children aged 3 to 6 years requiring nebulizer therapy were randomized 1:1 to either a dragon-themed colorful nebulizer mask (n=70) or a standard clear mask control group (n=70). A researcher-nurse recorded procedural metrics using a Demographic Information Form, the Fear Scale, and a Treatment Duration and Adherence Assessment Form. While baseline demographics were comparable (p > 0.05), children in the dragon-themed mask group experienced significantly lower fear scores (p < 0.001, Cohen d = 3.05; 95% CI: 2.56–3.54) and significantly shorter inhalation treatment durations (p = 0.012, Cohen d = 0.47; 95% CI: 0.14–0.81). Observed behavioral distress responses—such as crying, verbal refusal, anger, or mask removal attempts—did not differ significantly between groups (all p > 0.05).

Key takeaways

Parallel-group RCT randomized 140 preschool children aged 3–6 requiring nebulizer therapy in a tertiary pediatric ED to a dragon-themed mask or standard mask.
Children receiving nebulization via the dragon-themed mask demonstrated markedly lower procedural fear scores (p < 0.001, Cohen d = 3.05).
Treatment application duration was significantly reduced in the dragon-themed mask group (p = 0.012, Cohen d = 0.47).
Overt behavioral resistance measures (crying, anger, active mask displacement) were statistically similar between groups (p > 0.05).
Findings support low-cost, child-friendly design adaptations to standard emergency respiratory equipment to diminish pediatric fear and improve workflow.

Why this matters on shift

Pediatric emergency and clinic nurses frequently encounter acute distress, terror, and combative resistance from young children during aerosolized medication delivery. When children scream or fight the mask, drug pulmonary deposition drops sharply and treatment stretches out. Demonstrating that an inexpensive, themed visual mask substantially cuts fear scores and speeds up delivery provides bedside nurses an immediate, non-pharmacological strategy to improve shift efficiency and soothe pediatric patients.

Bedside takeaway

In a 140-child pediatric ED RCT, a dragon-themed nebulizer mask significantly lowered fear scores (d = 3.05) and shortened inhalation duration (p = 0.012) compared to standard masks in children aged 3–6.

Nursing implications

When initiating aerosolized bronchodilator or steroid therapy in preschool-age children, introduce child-friendly themed masks or gamified distraction to alleviate fear; secure an adequate seal around the nose and mouth while reassuring the child and caregiver throughout the nebulization cycle.

Limitations & cautions

Conducted at a single tertiary center in Turkey; open-label delivery precluded blinding of children, caregivers, and administering nurses; overt behavioral distress metrics showed no statistically significant between-group divergence.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of pediatric nursing (PubMed). The effect of using a dragon-themed nebulizer mask on treatment application duration, adherence, and fear in children presenting to the emergency department: A randomized controlled trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 3.8 million hospitalizations links each additional patient per nurse to 5.7% higher odds of 30-day adult in-hospital mortality

Systematic review of randomized trials demonstrates topical lidocaine significantly reduces acute pain and gag reflex discomfort during nasogastric tube insertion

Randomized trial of 140 preschool children in pediatric ED finds dragon-themed nebulizer mask substantially reduces fear and shortens treatment duration