Revised June 2021
Originally approved October 2015
The American College of Emergency Physicians (ACEP) supports and endorses the use of standardized nursing protocol orders (also referred to as standardized procedures, order sets, standing orders, or triage protocols) in the emergency department (ED) for initiation of patient evaluation and care prior to evaluation by a physician, nurse practitioner (NP), or physician assistant (PA). The use of such protocols is a patient-centric practice that is safe and effective in enhancing patient care. Standardized protocols have the potential to reduce variation in care, enhance workflow, improve coordination of care, and modify practice through evidence-based care.
ACEP is committed to ensuring that patients presenting to the ED receive timely high-quality care. Due to the nature of unscheduled care and unpredictable surges in patient volume and acuity, there are times when a physician, NP, or PA is not immediately available to initiate evaluation and care. In these instances, many facilities have found it beneficial to begin the evaluation and care of patients under standardized protocols enacted by nursing staff within their scope of practice that include but are not limited to:
Standardized protocols are a set of pre-approved orders that include a specifically defined patient population and clinical scenario(s) in which these orders may be carried out by nursing staff without any additional physician, NP, or PA input, approval, or order, either written or verbal.
ACEP encourages regulatory and credentialing bodies to develop their policies and procedures regarding standardized protocols with these considerations.
* This policy does not address standardized protocols used in the indirect supervision of PAs and NPs by physicians.