Economic and clinical outcomes of the nurse practitioner-led Sydney Adventist Hospital Community Palliative Care Service

Abstract

ObjectiveThe aim of this study was to assess the clinical, economic and personal impacts of the nurse practitioner-led Sydney Adventist Hospital Community Palliative Care Service (SanCPCS) MethodsParallel economic analysis of usual care was conducted prospectively with patients from the enhanced SanCPCS. A convenient retrospective sample from the initial service was used to determine the impact of the enhanced service on patient care. A time series survey was used with patients and carers from within the expanded service group in order to measure patient outcomes and values as they approached death. ResultsPatients of the SanCPCS were less likely to die in hospital and had fewer hospital admissions. In addition, the service halved the estimated hospitalisation cost per patient, but the length of hospital stay was not affected by the service. The SanCPCS was more beneficial for women in terms of fewer hospital admissions and lower costs. Patients’ choices regarding place of care and death and what was ‘important’ to them changed over time. For instance, patients tended to prefer being at home as they approached death, and being pain free doubled in importance. ConclusionsNurse practitioner-led community palliative care services have the potential to result in significant economic and personal benefits for patients and their families in need of such care. What is known about the topic?National trends show an emphasis on community services with the aim of promoting and supporting the choice of dying at home, and this coincides with drives to reduce hospital costs and length of stay. Community-based palliative care services may offer substantial economic and clinical benefits. What does this paper add?The SanCPCS was the first nurse practitioner-led community-based palliative care service in Australia. The expansion of this service led to significantly fewer admissions and deaths in hospital, and halved the estimated hospitalisation cost per patient. What are implications for practitioners?Nurse practitioner-led models for care in the out-patient or community setting are a logical direction for palliative services through the engagement of specialised providers uniquely trained to support, nurture, guide and educate patients and their carers.

The effectiveness of community-based palliative care programme components: a systematic review

“…Four studies specifically looked at various nurse-led programme roles. Of these, the studies examining quality of life reported no improvements from such programmes [ 64 , 65 ]. One study noted improvements in home deaths [ 64 ], while another reported no change in this outcome [ 66 ].…”

“…Of these, the studies examining quality of life reported no improvements from such programmes [ 64 , 65 ]. One study noted improvements in home deaths [ 64 ], while another reported no change in this outcome [ 66 ]. Similarly, hospital utilisation rates did not improve for two of the nurse-led programmes studied [ 64 , 67 ] but did in another study [ 65 ].…”

“…One study noted improvements in home deaths [ 64 ], while another reported no change in this outcome [ 66 ]. Similarly, hospital utilisation rates did not improve for two of the nurse-led programmes studied [ 64 , 67 ] but did in another study [ 65 ]. Qualitative research showed that both patients and staff were highly satisfied with these programmes [ 66 , 67 ].…”

Shared governance council to engage advanced practice registered nurses in a hospital setting

“…APRNs improve outcomes and enhance the financial value of health care (Coventry et al, 2017; Dubree et al, 2015; Moreton et al, 2020). APRN participation in shared governance helps organizations contain costs through improved role utilization, quality care, and job satisfaction (Condit & Hafeman, 2019; Proulx, 2021).…”

“…Yet hospitals with moderate-to-high nursing engagement demonstrate statistically significant improvements in job satisfaction, retention, patient experience, and burnout (Kutney-Lee et al, 2016). Advanced practice registered nurses (APRNs), inclusive of NPs, certified registered nurse anesthetists (CRNAs), clinical nurse specialists, and certified nurse midwives, are essential health care partners in the efforts of health care organizations to provide cost-efficient and high-quality care that improves patient access, outcomes, and experience (Aiken et al, 2021; Coventry et al, 2017; Htay & Whitehead, 2021; Moreton et al, 2020). However, the ability of APRNs to deliver highly specialized care also makes their turnover's financial and experiential costs extensive and disruptive to patient operations (Arthur et al, 2020; Han et al, 2018; Hartsell & Noecker, 2020).…”