Resource Commitment to Improve Outcomes and Increase Value at a Level I Trauma Center

Abstract

The addition of a dedicated TCU and advanced practice nurses improved the quality and reduced the cost of care, resulting in increased value at an adult Level I trauma center.

The influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma

“…In fact, the addition of NPs to the trauma team has resulted in added value in at least one other study. 9 It is possible that one reason for the slightly lower LOS was the higher number of UBNP patients who were discharged to home (67% vs. 60%) because placement in other health care facilities is often delayed by bed availability. It is not entirely clear why this difference exists, although it may be caused by the increased availability of the UBNPs to work with family members in teaching home care and dressing changes while the patient is still hospitalized.…”

Quality and Financial Impact of Adding Nurse Practitioners to Inpatient Care Teams

“…Costs associated with longer LOS and hospital complications have been shown to be decreased after the addition of NPs to the service. 12 Many NP practices use creative means, such as telephone outreach and home visits, to ensure patient care extends beyond the hospital stay, thereby decreasing readmission rates. 15 Overutilization of inpatient resources can be decreased by the addition of NPs through the consistent application of evidence-based guidelines in the ordering of diagnostics, treatments, and medications.…”

“…In many practice models, value is quantified in terms of revenue generation and cost-effectiveness of care. [2][3][4][5][6][7][8][9][10][11][12][13][14] The hiring of NP providers, however, also may have a considerable financial impact related to cost avoidance and improved outcomes in a value-based care design.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] Inpatient practices can be quite different from outpatient practice in terms of patient care outcomes and organizational goals. For instance, outcomes targeted toward an outpatient area might be decreased wait times, whereas an outcome valuable for an inpatient area would be decreased length of stay (LOS).…”

Scheduling of advanced practice providers at Level 1 trauma centers

“…7,8 In the wake of residency work hour restrictions, many trauma centers have dealt with this staffing challenge through the introduction of advanced practice providers (APPs), for example, nurse practitioners and physician assistants, as valuable adjuncts to residents in their staffing matrix. 11 Such is the case at our midwest US Level 1 trauma center where nurse practitioners first served as case managers in 1991, transitioned to clinic staff in 2002, and gradually assumed inpatient responsibilities as limits were imposed on resident work hours.…”