A Model for Integrating PNPs as Hospitalists

Abstract

<h3>Category/Date</h3> Practice Innovation poster presented at NAPNAP's 43^rd National Conference on Pediatric Health Care, March 23^rd, 2022 <h3>Background</h3> Hospitalist services that include certified pediatric nurse practitioners (CPNPs) as providers experience decreased length of hospital stay, improved patient outcomes, provider retention and improved medical and nursing education. CPNPs are also cost-effective providers when practicing at the top of their scope of practice. Despite these benefits, barriers still exist due to lack of knowledge regarding the CPNP role, scope of practice, and fiscal benefit. The aim of this quality improvement project is to develop a care delivery model that integrates the use of CPNPs as hospitalist in a children's hospital, emphasizing their fiscal benefit. <h3>Method</h3> IRB review and project approval was obtained. The three most common diagnoses on the hospitalist service from October 2019-March 2020 were identified. Patients hospitalized for bronchiolitis, asthma exacerbation, or diabetes during this time frame (N = 172), were evaluated for length of stay (LOS). LOS was compared to a target LOS to identify potential cost savings by reducing LOS, inclusive of CPNPs. Hospitalist average daily census was collected from 2019-2021 to determine patient-to-provider ratios and assess for the need of additional providers. Regional salaries for both CPNPs and pediatric hospitalists were compared and adjusted revenue was calculated using Georgia Medicaid reimbursement rates for an initial inpatient encounter of mild severity. A new care delivery model was developed outlining how to implement the role of CPNPs into the hospitalist service. <h3>Results</h3> Total potential savings by reducing LOS for the top three diagnoses over a time frame of 5 months is $77,368. Hospitalist average daily census for 2019 was 21 patients. While a lower average census was experienced during 2020 and 2021, likely due to the COVID-19 pandemic, the hospitalist service would benefit from the addition of a third provider team utilizing pre-pandemic data. Despite Georgia Medicaid reimbursement differences amongst physicians and CPNPs, salary differences allow for CPNPs to generate $40,000-$80,000 more in annual revenue compared to physicians. <h3>Conclusion</h3> In conjunction with CPNPs' high level of education and training, their cost-effectiveness and ability to care for hospitalized children makes the addition of a CPNP-led hospitalist provider team the most fiscally beneficial solution for improving quality of care and patient outcomes. The new care delivery model will be presented to key collaborators within the institution for consideration of the inclusion of CPNPs on the hospitalist service.