Nurse Practitioner Services Research Articles

Designing an interoperable patient portal to augment an Advanced Nurse Practitioner service for Children with hydrocephalus

BackgroundChildren's Health Ireland (CHI), who govern and operate acute paediatric services for the greater Dublin area, are also the client for the new children's hospital project which will be Ireland's first fully digital hospital. Design, development and implementation of digital solutions has been prioritised by the National Strategy for Children's Nursing to transform and accelerate nurse-led services. AimThe aim of this phase of a larger study was to explore the perspectives and opinions of key stakeholders on the requirements, benefits, and challenges for a bespoke patient portal, with a specific focus on the ANP-led Neurosurgical Service and children and young people with hydrocephalus. MethodsInterviews and focus groups were held online, and data were recorded and transcribed verbatim. Twenty-three participants across eight sites were interviewed including parents, healthcare professionals, experts and management/administrators. Data were analysed using Braun and Clarke's (2006) framework. ResultsFour key findings and considerations were identified in relation to patient portals in general and their interoperability with Electronic Health Records, as well as a bespoke patient portal for children and young people with hydrocephalus ConclusionsThe availability of a patient portal for children and young people with hydrocephalus would be hugely advantageous to their parents, the ANP led nursing service, and healthcare professionals in both the neurosurgical service at CHI and at regional healthcare organisations as well as for administration, research, and reports. More timely access to health data as well as a consistent log of information and communications between patients and healthcare professionals, would be more efficient and effective than current practices.The augmented ANP-led Neurosurgical Nursing Service at CHI will act as a pilot project from which other nurse-led digital patient services can learn from. Study RegistrationThis study was conducted between September 2022 and June 2023. It was registered in Trinity College Dublin, Ireland Twitter AbstractA study exploring requirements, benefits, & challenges for an interoperable patient portal in an ANP led Service for children with hydrocephalus

Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners’ experiences

Background Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. Aims The study aimed to explore healthcare practitioners’ experiences of implementation of a NP service in a rural setting. Methods Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. Findings Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. Conclusion Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.

Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure.

Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Older Persons Complex Care Nurse Practitioner model to reduce hospital readmissions: A pilot study

BackgroundPeople aged over 65 years are associated with increased numbers of co-morbidities, higher health care needs, an increased risk of fragmented care and are four times more likely to be hospitalised than those under 65 years. Nurse Practitioners (NP) working with older populations improved screening, clinical outcomes, patient satisfaction and provision of equal or better care for chronically ill patients. AimTo evaluate the effectiveness of the NP within the Older Persons Complex Care service to reduce hospital readmission rates in older complex patients. MethodsA pre and post pilot study using a retrospective clinical audit of medical records of patients referred to the NP service from January 2018 to April 2019 was undertaken. All patients reviewed by the NP were eligible for inclusion in the study and only those patients reviewed by the NP were included. FindingsSeventy seven patients were referred during the reporting period. Ages ranged from 64 to 98 years, and many co-morbidities were reported; minimum of two and maximum of 15 highlighting the complexity of the cohort. Management included education (100%), diagnostics (62%), medication changes (61%) and referrals (49%). DiscussionPatients managed within the service had reduced hospitalisations and many medications were ceased, reduced or titrated by the NP. Education was a key component of care. ConclusionThe value of NPs in the provision of care to older persons with complex, chronic diseases was highlighted with the potential to reduce readmissions, improve quality use of medicines and safe prescribing.

Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study.

The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300min (772.25±831.91 vs. 471.44±336.65, p=<.001). Similarly, time to place emergency department discharge order was shorter by 49min (277.76±159.69 vs. 228.27±116.04, p=.001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06±0.23 vs. 1.46±0.74, p<.001). The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non-randomised, concurrent mixed methods study protocol.

The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). The concurrent mixed-method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes.

Employing nurse practitioners in general practice: an exploratory survey of the perspectives of managers.

INTRODUCTION Establishing the nurse practitioner (NP) workforce in New Zealand is a viable solution to health and workforce challenges in primary health care. General practices have been slow to implement NP services. Managers of general practices are central to the employment and development of NP roles. AIM To explore the perspectives of managers on employing NPs in general practice. METHODS An electronic survey was used to collect demographic and numerical data, which were analysed descriptively and analytically using SPSS (version 26). Written answers to open-ended questions were analysed qualitatively. RESULTS In total, 143 managers participated in the survey (response rate 39.7%); 54 (37.8%) worked in practices employing at least one NP. Of respondents, 88.9% (n = 127) agreed or strongly agreed that NPs could enhance continuity of care (89/143, 62.2%), improved access to services and medications (89/143, 62.2%) and filled a gap that added value to health care (97/143, 67.8%). Practices employing NPs had statistically significant higher levels of agreement about the advantages of NPs than practices not employing NPs. Challenges and enablers to employing NPs were themed under organisational environment, NP scope of practice and role, and NP workforce development. DISCUSSION This exploratory study revealed that there is little knowledge about the NP workforce in surveyed general practices. Ongoing work is required to improve knowledge for employing general practices, including dissemination of information about NP education and training, scope and models of care, and ability to generate business income.

Clinician experience, perceptions, and acceptance of paediatric complex care nurse practitioner roles

ABSTRACT Background Nurse practitioner (NP) roles are implemented to increase access to care in response to rising demands and pressures in the health system, yet little evaluation is undertaken to assess how these new roles integrate with services. Aim To identify health professionals’ experiences, perceptions, and acceptance of NP roles in complex care medical subspecialties within a paediatric tertiary hospital and health services. Methods The AUSPRAC validated survey was distributed in both electronic and paper forms to a purposeful cohort of multidisciplinary health professionals (n = 208) working directly or collaboratively with both established NPs and novice/in training NPs. Nine medical subspecialties were represented including metabolic, immunisation and oncology. Two reminders were sent to non-responders. All NP roles within nine medical specialties were evaluated. Data were tabulated and descriptively analysed. Findings Ninety-two responses were received (response rate 44%). Services with highest representation were Immunisation (71%), Metabolic Medicine and Palliative Care (45%) each. Responses were received from medical (42%) nursing (30%) and other healthcare providers (27%) including allied health clinicians. Most respondents agreed they understood NP roles (89%), agreed their introduction into the service had been a success (85%) and that NP services met the needs of the patients (91%). Some (9%) respondents reported they feared NP prescribing increased the risk of incorrect treatment with 7% not trusting NPs to diagnose correctly and some (15%) worried that NPs did not have the necessary knowledge to prescribe. Free text comments were generally positive and supportive of the roles, with few negative statements. Discussion While most NP roles were positively viewed, breakdowns in communication processes affected understanding and acceptance of some NP roles. Clearly defining the scope, purpose and benefits of NP roles should be communicated to individual teams and across whole organisations. Conclusion NP roles are largely well accepted within this paediatric tertiary service, which demonstrates a shift in culture from research undertaken at the turn of the century. Attention to implementation factors may improve successful integration of new roles into services.

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand's Primary Health Care Sector.

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand's strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a "hands-off" approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

A multimorbidity nurse practitioner-led clinic: Evaluation of health outcomes

BackgroundHealthcare services for people living with multiple chronic diseases have traditionally been organised around each condition, an approach which is neither resource-efficient nor convenient or effective for patients. The integrated nurse practitioner service reported here was developed to optimise patient experience and outcomes within a chronic disease self-management framework. AimTo evaluate patient outcomes following attendance at an integrated chronic disease nurse practitioner clinic for multimorbidity. MethodsA prospective service evaluation of adults with any combination of chronic kidney disease, diabetes and/or heart failure between June 2014 and December 2017. Demographic and clinical outcomes at entry and after 12 months of clinic attendance were collected from health records of all patients (n = 162); a subgroup also completed health-related quality of life and self-efficacy measures at entry and 12 months follow-up (n = 106). FindingsPatients attending the clinic had complex needs and poor health-related quality of life. Despite the complexity of their health problems, as a cohort blood pressure was well-controlled and self-efficacy for chronic disease management was relatively high. Over the first 12 months of integrated nurse practitioner care, there were large improvements in physical aspects of health-related quality of life and many patients achieved reductions in body mass index. Use of hospital inpatient and emergency services also decreased. DiscussionNurse practitioner-led services have the potential to reduce treatment burden and deliver integrated chronic disease management. ConclusionsThe multimorbidity clinic has improved health outcomes in this patient cohort and offers a model for enhanced primary care.

Evaluating alcohol intoxication management services: the EDARA mixed-methods study

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

6D2 Acupuncture for Pain: A Feasibility Study for the Integrative NP Pain Service

This IRB approved research study aims to explore the feasibility of Acupuncture as a nonpharmacologic modality for the treatment of pain in patients admitted to a hospital setting with a primary or secondary diagnosis of uncontrolled pain. Acupuncture has been extensively quoted in the literature as a recommended nonpharmacologic modality for the treatment of pain(American College of Physicians,2017). As a Pragmatic Pilot Study using a convenience sample of patients who experience uncontrolled pain and have been referred to a Pain NP service, the impact of Acupuncture on pain, function, LOS, patient satisfaction and workflow of the pain service will be explored. It is expected that the findings of this study will add to the current body of literature on nonpharmacologic pain modalities and provide a foundation for the expansion of integrative modalities with further research opportunities for a inpatient pain management Nurse Practitioner (NP) Service.

635 Cost-Effectiveness of a Heart Failure Nurse Practitioner Service for Patients Hospitalised With Acute Heart Failure

Heart failure (HF) nurse practitioners (NP) are part of the HF specialist workforce however their impact on improving patient outcomes is untested. To determine the cost effectiveness of a HF NP service compared to current practice of no HF NP service from a health system perspective. A post-hoc analysis was undertaken from a pre and post intervention study of a HF NP service. A total of 500 patients admitted to a single centre with acute HF (250 patients in the historical control (HC) and 250 in the prospective HF NP group) were followed up for 12 months post-discharge. Patients were matched on five-year age groups. Economic modelling was used to estimate the cost-effectiveness of a HF NP service. The mean age was 77.7±11years (SD). At 12 months post-discharge, 73.7% of patients in the HF NP group were readmitted compared to 81.7% in the HC (p=0.03). The HF NP group, compared to HC, was more costly ($28693 vs $27788) but more effective (1.97 vs 1.93 QALY). Cost of 12-month readmissions was $20748 in the HF NP group compared to HC of $28682. The HF NP service was cost-effective with a mean ICER of $14170/QALY gained at 12 months with a 100% probability of being cost-effective at a willingness-to-pay threshold of $50000. The HF NP service was cost-effective with a high degree of certainty. The main cost driver was hospital readmissions with the HF NP group experiencing a significantly lower rate of readmissions.

HOSPICE VISIT INTENSITY BY PHYSICIANS AND NURSE PRACTITIONERS ON THE GENERAL INPATIENT LEVEL OF CARE

The Medicare Hospice Benefit’s General Inpatient (GIP) level of care provides short-term services for pain and symptom management in an inpatient facility that cannot be managed in the patient’s home. Relatively little is known about how beneficiaries utilize services during GIP care. Among a cohort of Medicare hospice beneficiaries utilizing GIP during Federal Fiscal Year 2014 (FY2014), we used 100% Medicare hospice and Part B claims to identify physician and nurse practitioner services concurrent with GIP dates. We estimated logistic regression models to determine the likelihood a beneficiary never receives physician or nurse practitioner services. We found that among the 1.5 million GIP days serviced in FY2014, more than half (52.4%) lacked any recorded physician or nurse practitioner services. Absence rates for these services were particularly high among hospice GIP days provided in inpatient facilities (69.1% missing services), long-term care hospitals (84.3% missing services), and skilled nursing facilities (85.3% missing services). Moreover, one in five hospice episodes having at least three sequential GIP days lacked any physician or nurse practitioner services. Relative to hospice inpatient units, rates of absence were higher among episodes beginning in long-term care hospitals [59.3% long-term care hospital vs. 11.5% hospice inpatient units; AOR 9.65 95% CI 7.47-12.46] and skilled nursing facilities [51.3% skilled nursing facility vs. 11.5% hospice inpatient units; AOR 5.98, 95% CI 5.63-6.36]. More in depth research and monitoring is needed to further understand dimensions of GIP care provision, to ensure that hospice beneficiaries are receiving adequate services regardless of their inpatient setting.

Establishing value from contemporary Nurse Practitioners’ perceptions of the role: A preliminary study into purpose, support and priorities

ProblemTo establish greater understanding into nurse practitioners and their value within healthcare. HypothesisValue in healthcare, when used as a tool of healthcare economics, is a marker for effective service recognition. Value cannot be determined without understanding, the lack of descriptive properties about Australian nurse practitioners contributes to the gap in understanding the value of the nurse practitioner service. DesignIn this preliminary study we tested a concurrent triangulation design comprising of a three-part on-line questionnaire eliciting participating clinician's views of their nurse practitioner role. SettingNurse practitioners from one rural and one metropolitan Local Health District of New South Wales, Australia were surveyed. Thirty-five surveys were distributed to practitioners with an overall response rate of 77.5% (n=27). ResultsData analysis reveals that nurse practitioners primarily perceive they address healthcare access gaps. Most nurse practitioners reported it was easy to maintain their practice whilst reporting they found it difficult to attend education and consequently expand their practice. Nurse practitioners opinions were mixed when reporting the level of support from their employers. ConclusionNurse practitioners perceive their roles exist to meet shortfalls in health service delivery. Nurse practitioners identified the need for specialist nurse practitioner education and perceived varying support for their roles. Results qualify a more informed value judgement of the nurse practitioner role.

Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients.

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.

Bringing Health Care Home: A Pilot Project to Improve Access to Primary Health Care Using Mobile Nurse Practitioner Services

Bringing Health Care Home: A Pilot Project to Improve Access to Primary Health Care Using Mobile Nurse Practitioner Services

Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement.

In the midst of the nationwide opioid epidemic, our institution began an effort to improve the education of opioid prescribers and disseminate procedure-specific guidelines for the number of opioid pills to prescribe post-operatively for total joint arthroplasty. The number of opioid pills suggested for total hip or knee replacement was 70 tablets. We sought to evaluate the impact of the new institutional guideline on opioid prescribing practices, hypothesizing that it would lead to a decrease in the number of pills prescribed but an increase in patient call volume after discharge. After the new guidelines were implemented in February 2018, we retrospectively reviewed all opioid prescriptions written for patients on the joint-replacement service from March 2016 to March 2018. In addition, we tabulated post-operative telephone calls made to the nurse practitioner service before and after guideline implementation. The majority of calls to the nurse practitioner service are for opioid renewals. We included 9514 patients in the analysis. Prior to guideline implementation, the mean number of pills prescribed after primary total joint arthroplasty was 91 ± 26.6 pills and after it was 65 ± 16.3 pills. The monthly number of unique patient telephone interactions was statistically significantly lower after the implementation of the new guidelines. An institutional guideline for opioid prescribing after total joint arthroplasty significantly reduced the number of pills prescribed to patients without causing a significant increase in the number of phone calls to the service.