Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients

Abstract

Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending. The complexity of elderly trauma care and the need to evaluate the efficacy of management provided by NPs led to the development of the current study. Accordingly, this study endeavored to compare outcomes in elderly patients whose care was coordinated by trauma NP (TNP) versus nontrauma NP (NTNP) services. Patients under the care of TNPs had a 1.22-day shorter duration of hospitalization compared with that of the NTNP cohort (4.38 ± 3.54 vs. 5.60 ± 3.98, p = .048). Decreased length of stay in the TNP cohort resulted in an average decrease in hospital charges of $13,000 per admission ($38,053 ± $29,640.76 vs. $51,317.79 ± $34,756.83, p = .016). A significantly higher percentage of patients admitted to the TNP service were discharged home (67.1% vs. 36.0%, p = .002), and a significantly lower percentage of patients were discharged to skilled nursing facilities (25.7% vs. 51.9%, p = .040). These clinical and economic outcomes have proven beneficial in substantiating the care provided by TNPs at the study institution. Future research will focus on examining the association of positive outcomes with specific care elements routinely performed by the TNPs in the current practice model.

The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

“…The positive facilitator theme presence of NPs decreasing hospitalizations was mentioned in 37 of 136 occurrences, or 27.21% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The presence of NPs also improved health outcomes was mentioned in 27 of 136 occurrences of facilitator themes, or 19.85% [ 7 , 9 , 12 , 14 , 20 , 21 , 23 , 24 , 26 , 28 , 29 , 30 , 31 ]. Improved patient and family satisfaction were mentioned in 2 of 136 occurrences of facilitator themes, or 1.47% [ 19 , 32 ].…”

“…Multidisciplinary approach was mentioned in 5 of 136 occurrences of facilitator themes, or 3.68% [ 21 , 25 , 29 , 32 ]. Reduced healthcare costs were mentioned in 9 of 136 occurrences of facilitator themes, or 6.62% [ 7 , 8 , 9 , 12 , 14 , 23 , 30 ]. Unrestrictive or least restrictive scope of practice for NPs was mentioned in 10 of 136 occurrences of facilitator themes, 7.35% [ 10 , 14 , 16 , 17 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…Successful strategies in which NPs decreased hospitalizations included NP-led advance care planning, medication reconciliation interventions, employing full-time NP at skilled nursing facilities, NPs providing patient-centered care, increased access and availability of full-practice NPs, staff coaching and education, and on-site assessments [ 7 , 8 , 10 , 11 , 12 , 13 , 17 , 20 , 22 , 23 , 24 , 25 , 26 ].…”

“…Many of the articles reviewed indicated NPs were a valuable resource to prevent unnecessary hospitalizations and clearly impacted a reduction in emergency room visits and hospitalizations particularly among the frail elderly and seniors [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Elderly patients managed by NPs had a lower hospital length of stay, were provided person-centered care, and a significant difference was found in the relationship between the number of NP discussions with patients about care and the number of hospitalizations [ 7 , 20 , 23 ]. Skilled nursing facilities implementing an NP-led medication reconciliation intervention lead to reduction in all-cause hospital readmissions [ 8 ].…”

“…The positive facilitator theme presence of NPs decreasing hospitalizations was mentioned in 37 of 136 occurrences, or 27.21% . The presence of NPs also improved health outcomes was mentioned in 27 of 136 occurrences of facilitator themes, or 19.85% [7,9,12,14,20,21,23,24,26,[28][29][30][31].…”