Thursday, November 3, 2011

Loyola Nurse Practitioner Reduces Unnecessary Emergency Department Visits

Clinical role improves continuity in care and utilization of resources

MAYWOOD, Ill. -- Adding a nurse practitioner (NP) to a busy hospital staff can decrease unnecessary emergency department (ED) visits, according to a study published in the latest issue of Surgery by researchers at Loyola University Health System. Researchers found that the nurse practitioner reduced ED visits by improving the continuity in care and troubleshooting problems for patients. The addition of an NP also resulted in an improved use of resources and financial benefits for the health system.

“This study demonstrates the important role that nurse practitioners have in our increasingly complex health-care system,” said senior author Margo Shoup, MD, FACS, Division Director of Surgical Oncology, Loyola University Health System. “With resident work restrictions and changes in reimbursement, the addition of a nurse practitioner to a busy practice can fill a void and maintain communication and care after a patient is released from the hospital."

This study evaluated the addition of an NP to a department with three surgeons. Patient records were analyzed one year before (415 patients) and one year after (411 patients) the NP joined the staff. The two groups were statistically similar in age, race, type of surgery, length of hospital stay and hospital readmissions. Patients were tracked after they were sent home from the hospital to determine how many unnecessarily returned to the ED. Researchers defined this as an ED visit that did not result in an inpatient admission.

Mary Kay Larson, BS, MSN, CNN, APRN-BC, is the nurse practitioner who was involved with this study. She communicated with patients and coordinated their discharge plan. Telephone conversations with patients increased by 64 percent during this time. Visiting nurse, physical therapy or occupational therapy services also increased from 25 percent before Larson joined the department to 39 percent after. These services resulted in significantly fewer unnecessary ED visits (25 vs. 13 percent) after she was involved.

“The major decrease in ED visits was due in large part to the communication I had with patients after they left the hospital,” Larson said. “I routinely checked on their progress and responded to their concerns by ordering lab tests, calling in prescriptions and arranging to care for them in the outpatient setting to maintain continuity in treatment."

In 2003, resident work hours were restricted to 80 hours per week by the Accreditation Council for Graduate Medical Education. Hospitals have had to make adjustments to ensure patients continue to receive the best possible care. LUHS found that adding an NP to this department helped to accommodate this change without jeopardizing patient care.

“Hospitals must continue to adapt to the changing health-care environment,” said Dr. Shoup, who also is an associate professor in the Department of Surgery at Loyola University Chicago Stritch School of Medicine. “The addition of a nurse practitioner clearly represents a way that we can adjust to meet the increasing demands of patient care while we are being asked to do more with less."

Additional LUHS investigators involved in this study included lead author Lourdes Robles, MD; Michele Slogoff, MD, FACS; Eva Ladwig-Scott, MD; Dan Zank, MD; Larson; and Gerard V. Aranha, MD, FRCSC, FRCSC.

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.