Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction

Collins, Nina; Miller, Richard R.; Kapu, April N.; Martin, Rita J.; Morton, Melissa; Forrester, Mary Gore; Atkinson, Shelley; Evans, Bethany; Wilkinson, Linda

doi:10.1097/ta.0000000000000097

Cited by 71 publications

(75 citation statements)

References 9 publications

(7 reference statements)

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“…4,7,8,23,[26][27][28][29][30] Significant reductions in hospital and intensive care unit LOS have been reported after the addition of PEs to surgical or trauma services. [7][8][9][10][11][12][13][14] Morbidity and mortality remain stable, and some studies have shown a reduction of in-hospital complication rates. An overall improvement in quality of care and continuity of care, as judged by health care workers, is a frequent theme in the studies we reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,14,15,21,23,27,30,31 It is important that we critically examine the effect that these changes have on the hospital work environment, and most importantly on patient care, before advocating widespread adoption.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14] One paper found the LOS unchanged. Six articles reported actual LOS improvements, which ranged from 0.25 to 2 days (Table 3).…”

Section: Length Of Staymentioning

confidence: 99%

“…Two groups reported savings of more than $5000 per patient. 10,14 Bohm and colleagues 29 reported increased surgical volumes and reduced wait list times without changes in expenditure. The studies reporting financial outcomes originated from 3 different health care systems (Canada, United States, United Kingdom), which decreases the generalizability of the results.…”

Section: Included Studies 29mentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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Background: With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. Methods:We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles.Results: Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs. Conclusion:The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.Contexte : Compte tenu de la réduction du nombre d'heures de travail des médecins résidents et de la pénurie de stagiaires qui en a résulté, une solution à long terme s'impose pour assurer la sécurité et l'efficacité des soins aux patients. Une solution consiste à intégrer des infirmières praticiennes (IP) et des adjoints aux médecins (AM) dans divers contextes de soins de santé. Nous avons voulu examiner l'incidence du recours aux IP et aux AM dans des services de chirurgie et de traumatologie et son effet sur la santé des patients et sur la charge de travail des médecins résidents.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14] One paper found the LOS unchanged. Six articles reported actual LOS improvements, which ranged from 0.25 to 2 days (Table 3).…”

Section: Length Of Staymentioning

confidence: 99%

Section: Included Studies 29mentioning

confidence: 99%

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Physician extenders on surgical services: a systematic review

Johal

Dodd

2017

CJS

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“…Many institutions are implementing alternative staffing models that include use of NPs and PAs to meet the needs of acute and critically ill patients, and recent reports highlight the benefit to providing quality of care in the ICU. [23][24][25][26][27][28][29] Additional research is needed to determine optimal NP or PA provider to patient ratios based on factors such as changes in patient acuity levels, need for invasive and therapeutic procedures, daily admission and discharge numbers, educational needs of patients and patients' families, and time spent by advanced practice providers in nonclinical duties. This research is especially important, because the roles of NPs and PAs are extending beyond general patient care management to include oversight of evidence-based practice initiatives and clinical staff education.…”

Section: Discussionmentioning

confidence: 99%