Central Surgical Association| Volume 150, ISSUE 4, P711-717, October 2011

The addition of a nurse practitioner to an inpatient surgical team results in improved use of resources


      Resident work hour restrictions and changes in reimbursement may lead to an adverse effect on the continuity of care of a patient after discharge. This study analyzes whether adding a nurse practitioner (NP) to a busy inpatient surgery service would improve patient care after discharge.


      In 2007, a NP joined a team of 3 surgery attendings. She coordinated the discharge plan and communicated with patients after discharge. We reviewed the records of patients 1 year before (N = 415) and 1 year after (N = 411) the NP joined the team. The discharge courses of the patients were reviewed, and an unnecessary emergency room (ER) visit was defined as an ER visit that did not result in an inpatient admission.


      The 2 groups were statistically similar with regard to age, race, acuity of the operation, duration of hospital stay, and hospital readmissions. Telephone communication between nurses and discharged patients was 846 calls before the NP and 1,319 calls after the NP, representing an increase of 64% (P < .0001). Visiting nurse, physical therapy, or occupational therapy services were rendered to only 25% of patients before the NP compared to 39% after (P < .0001). There were more unnecessary ER visits before the NP (103/415; 25%) compared to after (54/411; 13%) (P = .001).


      Adding a NP to our inpatient surgery service led to an overall improvement in the use of resources and a 50% reduction in unnecessary ER visits. This study shows that the addition of a NP not only improves continuity of care on discharge but also has the potential to yield financial benefits for the hospital.
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        • McCorkle R.
        • Dowd M.
        • Ercolano E.
        • Schulman-Green D.
        • Williams A.L.
        • Siefert M.L.
        • et al.
        Effects of nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers.
        Psychooncology. 2009; 18: 62-70
        • Hammar T.
        • Rissanen P.
        • Perälä M.L.
        The cost-effectiveness of integrating home care and discharge practice for home care patients.
        Health Policy. 2009; 92: 10-20
        • van der Sluis C.K.
        • Datema L.
        • Saan I.
        • Stant D.
        • Dijkstra P.U.
        Effects of a nurse practitioner on a multidisciplinary consultation team.
        J Adv Nurs. 2009; 65: 625-633
        • Haan J.M.
        • Dutton R.P.
        • Willis M.
        • Leone S.
        • Kramer M.E.
        • Scalea T.M.
        Discharge rounds in the 80-hour workweek: importance of the trauma nurse practioner.
        J Trauma. 2007; 63: 339-343
        • Bahouth M.
        • Esposito-Herr M.B.
        • Babineau T.J.
        The expanding role of the nurse practioner in an academic medical center and its impact on graduate medical education.
        J Surg Educ. 2007; 64: 282-288
        • Christmas A.B.
        • Reynolds J.
        • Hodges S.
        Physician extenders impact trauma systems.
        J Trauma. 2005; 58: 917-920
        • Jenks S.F.
        • Williams M.V.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Lundberg S.
        • Wali S.
        • Thomas P.
        • Cope D.
        Attaining resident duty hours compliance: the acute care nurse practioners program at Olive View-UCLA Medical Center.
        Acad Med. 2006; 81: 1021-1025
        • Litaker D.
        • Mion L.
        • Planavsky L.
        • Kippes C.
        • Mehta N.
        • Frolkis J.
        Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care.
        J Interprof Care. 2003; 17: 223-237
        • Ather S.
        • Chung K.D.
        • Gregory P.
        • Demissie K.
        The association between hospital readmissions and insurance provider among adults with asthma.
        J Asthma. 2004; 41: 709-713
        • Bodenheimer T.
        • Berry-Millett R.
        Follow the money—controlling expenditures by improving care for patients needing costly services.
        N Engl J Med. 2009; 361: 1521-1523
        • Sledge W.H.
        • Brown K.E.
        • Levine J.M.
        • Fiellin D.A.
        • Chawarski M.
        • White W.D.
        • et al.
        A randomized trial of primary intensive care to reduce hospital admissions in patients with high utilization of inpatient services.
        Dis Manag. 2006; 9: 328-338
        • Hammond J.
        Home health care cost effectiveness: an overview of the literature.
        Public Health Rep. 1979; 94: 305-311