A Retrospective Cohort Study of the Impact of Nurse Practitioners on Hospitalized Patient Outcomes

Abstract

The role of advanced practice providers has expanded in the hospital setting. However, little data exist examining the impact of these providers. Our purpose was to determine the effect of adding nurse practitioners in a complementary role on the quality and efficiency of care of hospitalized patients. A retrospective cohort study evaluated adult patients admitted by private physicians (without house staff or non-physician providers) to a general medical-surgical unit in an academic medical center. The admissions department allocated patients as beds became available and nurse practitioners were assigned to patients until their caseload was reached. Outcomes included length of hospital stay, in-hospital mortality, admission costs, 30-day readmissions, transfer to a more intensive care level, and discharge order time. Of the 382 patients included in this study, 263 were assigned to the nurse practitioner group. Hospital mortality was lower in the nurse practitioner group [OR 0.11 (95% CI 0.02–0.51)] as was transfer to more intensive care level [OR 0.39 (95% CI 0.20–0.75)]; however, the nurse practitioner group had longer length of stay (geometric mean = 5.80 days for nurse practitioners, 3.63 days for no nurse practitioners; p < 0.0001) and higher cost per patient (geometric mean = USD 6631 vs. USD 5121; p = 0.005). The results were unchanged when models were adjusted for potential confounders. Adding nurse practitioners can yield improved clinical outcomes (lower hospital mortality and fewer transfers to intensive care), but with a potential economic expense (longer hospital stays and higher costs).

Cost-Effectiveness Analysis of Improving Nurses’ Education Level in the Context of In-Hospital Mortality

“…Verification of the clinical effectiveness and cost of the impact of qualified nurses (nurse practitioners) on the clinical outcomes of patients hospitalised in surgical and non-surgical wards indicated a link with lower in-hospital mortality, but these clinical benefits are associated with higher financial costs. However, the improvement in nursing care in non-surgical wards is all the more important, because, according to research, the risk of death for these wards is more than 50% higher, and the probability of avoidable death is lower than in surgical wards [ 29 ].…”