Addition Of Nurse Practitioners Research Articles

Buprenorphine prescription dispensing rates and characteristics following federal changes in prescribing policy, 2017-2018: A cross-sectional study

BackgroundExpansion of buprenorphine for opioid use disorder treatment is a core component of the opioid overdose epidemic response. The Comprehensive Addiction and Recovery Act (CARA) of 2016 authorized nurse practitioners (NPs) and physician assistants (PAs) to obtain a DATA-waiver to prescribe buprenorphine. The objectives of this study are to examine national- and county-level buprenorphine prescription dispensing, patterns by patient demographics and clinician specialty, and county-level characteristics associated with buprenorphine dispensing. MethodsRetrospective analysis of buprenorphine prescriptions dispensed from approximately 92% of all retail prescriptions in the US (2017–2018). Analyses include rates of buprenorphine prescriptions dispensed, by patient demographics and prescriber specialty, changes in buprenorphine prescriptions dispensed at the national- and county-level, and county-level characteristics associated with buprenorphine dispensing. ResultsBuprenorphine prescriptions dispensed increased by 9.1% nationally, from 40.7–44.4 per 1000 residents. From 2017 to 2018, NPs (351.9%) and PAs (257.3%) had the largest percent increases in dispensed buprenorphine prescriptions, accounting for 79.6% of the total increase. In 2018, county-level characteristics associated with high buprenorphine dispensing included. among others: greater potential buprenorphine treatment capacity, higher drug overdose death rates, and higher rates of Medicaid enrollment. Rural counties were associated with low buprenorphine dispensing. ConclusionBuprenorphine dispensing rates increased in the US from 2017 to 2018, suggesting the addition of NPs and PAs by CARA has contributed to an increase in dispensed buprenorphine prescriptions.

Evaluation of a nurse practitioner-led project to improve communication and collaboration in the acute care setting.

Effective communication between patients and the health care team is essential. The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey measures discharged patients' perceptions of their hospital experience, including nurse and doctor (physician) communication. These scores affect hospital reimbursement for Medicare and Medicaid patients. In 2015, the project facility was penalized for low HCAHPS scores, causing a loss in revenue. The facility's medical-surgical unit scores were still failing in 2016. A quality improvement project on Interprofessional Bedside Rounds (IBR) was designed and implemented, and the effect of hiring nurse practitioners (NPs) to the unit's hospitalist service was also examined. Analysis of variance was used to detect significant changes in nurse and doctor HCAHPS communication scores from baseline in 2016, after NPs were hired in 2017, and post-IBR in 2018. The Interprofessional Collaborative Competency Attainment Scale (ICCAS) was also used to measure changes in staff competencies. The IBR intervention was conducted with the NP, nurse, and doctor present. It was structured to promote effective communication and patient engagement. Hospital Consumer Assessment of Health Care Providers and Systems scores improved, with nurse scores increasing from 2016 (79%) to 2017 (86%) to 2018 (90%) (p = .310). Doctor scores improved from 2016 (69%) to 2017 (88%) but slightly decreased to 2018 (85%) (p = .040). Interprofessional Collaborative Competency Attainment Scale results showed a 29% improvement in staff's perceived ability to collaborate (p = .000). Results indicate that the addition of NPs greatly improved HCAHPS communication scores. To improve communication, medical-surgical units should consider a team-based approach that includes NP leadership for implementing evidence-based interventions such as IBR.

Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department

BackgroundLittle is known about the clinical management or quality of asthma care provided by nurse practitioners (NP) in a pediatric emergency setting. ObjectiveTo describe the clinical management of asthma by NPs in our institution’s emergency department, and to compare the treatment strategies between NPs, pediatricians, and pediatric emergency physicians. MethodsWe conducted a retrospective chart review at a level-one pediatric trauma center. Data were extracted from electronic medical records for all patients between 2 and 18 years of age presenting to the emergency department with an asthma exacerbation. Data were analyzed using binary logistic regression with generalized estimating equations. ResultsNPs evaluated 18% of all children presenting for asthma care. When compared to pediatric emergency physicians, patients treated by NPs had approximately twice the odds of receiving a β2-agonist (OR = 2.02; 95% CI 1.02 – 3.99) or a systemic corticosteroid (OR = 2.31; 95% CI 1.35 – 3.95) within 60 minutes of clinical evaluation. Adherence rates were similar for the other asthma quality measures between these two clinician groups. ConclusionsNPs were best able to meet time-sensitive asthma quality measures in the emergency department. The addition of NPs to emergency staffing models may improve access to timely care for children with asthma.

The impact of the addition of nurse practitioners to surgical intensive care units: A retrospective cohort study

BackgroundDemand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated. ObjectivesTo compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team. MethodsWe conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation. ResultsA total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions. ConclusionIncorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.

Physician extenders on surgical services: asystematic review.

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. 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. 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. 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.

Cardiac Acute Care Nurse Practitioner and 30-Day Readmission

The utilization outcomes of nurse practitioners (NPs) in the acute care setting have not been widely studied. The purpose of this study was to determine the impact on utilization outcomes of NPs on medical teams who take care of patients admitted to a cardiovascular intensive care unit. A retrospective 2-group comparative design was used to evaluate the outcomes of 185 patients with ST- or non ST-segment elevation myocardial infarction or heart failure who were admitted to a cardiovascular intensive care unit in an urban medical center. Patients received care from a medical team that included a cardiac acute care NP (n = 109) or medical team alone (n = 76). Patient history, cardiac assessment, medical interventions, discharge disposition, discharge time, and 3 utilization outcomes (ie, length of stay, 30-day readmission, and time of discharge) were compared between the 2 treatment groups. Logistic regression was used to identify predictors of 30-day readmission. Patients receiving care from a medical team that included an NP were rehospitalized approximately 50% less often compared with those receiving care from a medical team without an NP. Thirty-day hospital readmission (P = .011) and 30-day return rates to the emergency department (P = .021) were significantly lower in the intervention group. Significant predictors for rehospitalization included diagnosis of heart failure versus myocardial infarction (odds ratio [OR], 3.153, P = 0.005), treatment by a medical team without NP involvement (OR, 2.905, P = 0.008), and history of diabetes (OR, 2.310, P = 0.032). The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.

Neurocritical Care Clinicians’ Perceptions of Nurse Practitioners and Physician Assistants in the Intensive Care Unit

The contributions and perceptions of staff regarding nurse practitioners (NPs) and physician assistants (PAs) in neuroscience intensive care units (ICUs) throughout the country are not well known. The objectives of this study were to determine the impact of neuroscience NPs and PAs and assess demographics of ICUs. All members of the Neurocritical Care Society were asked to complete a survey to obtain their perception regarding the addition of NPs and PAs to the ICU team. Participants rated the abilities of NPs and PAs to provide safe patient care, promote a team environment, anticipate or prevent neurological deterioration, address patient or staff concerns in a timely manner, and communicate effectively on a Likert scale of 1-5. In addition, members were asked to provide basic demographics and background information on the type and size of ICU, type of provider in charge, and role of NPs and PAs in their ICU, including procedures performed, documents written, and number of patients per provider. Both quantitative and qualitative data were collected and analyzed. A Mantel-Haenszel chi square and ordinal logistic regression model were used to determine the relationship between the background information and the perception of the abilities of NPs and PAs. The study cohort was composed of 10% of Neurocritical Care Society members. Additional responsibility of NPs and PAs was associated with higher scores in safety, the ability to promote a team environment, address patient or staff concerns, communication, and most importantly, the ability to anticipate or prevent a neurological deterioration (all ps < .0001). Number of NPs and PAs, number of years of employing NP/PAs, number of procedures, and amount of documentation also positively affected safety. Additional responsibility of NPs and PAs has strong potential to improve staff, patient, and family satisfaction and safety and prevent neurological deterioration. Thus, NPs and PAs should be utilized to the full extent of their role.

The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3-2.1, p < 0.05) and 2.1 (95% CI 1.6-2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%-39.0%, p < 0.01) and 48.8% (95% CI 35.0%-62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%-63%, p < 0.01) and 71% (95% CI 53%-96%, p < 0.05), respectively. The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.