Background
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.
Methods
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.
Results
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).
Conclusion
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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Article info
Publication history
Accepted:
August 18,
2011
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
