When NPs team up with physicians and hospitalists, their patients are discharged earlier than comparable patients receiving standard care, according to a new study. This team approach also reduces costs without raising hospital-readmission or mortality rates for up to four months after discharge.
In the Multidisciplinary Doctor Nurse Practitioner (MDNP) study, the MDNP team provided care to 581 general medical patients in the experimental group, while a control group of 626 comparable patients received usual care. The MDNP team coordinated patient care during daily rounds and assessed patients' clinical status twice daily. The control group's care team met once weekly for 90 minutes.
A hospitalist, a full-time in-hospital medical director, coordinated the activities of the MDNP team, wrote protocols for specific diseases' treatments and procedures, held weekly meetings with the NPs, and was always available by phone. The NPs provided case management by coordinating communication between physicians and nurses, monitoring antibiotic regimens and medications, and following up with patients by phone for a month after discharge.
The average length of stay in the experimental group was five days, compared with six days in the control group. Mortality and readmission rates within four months after discharge were similar in both groups. Although NP salaries increased the cost of care, the hospital still realized a "backfill profit"-that is, profit derived from being able to admit more patients-of $1,591 per patient in the experimental group, as new patients filled the vacated beds. The loss of income from discharging these patients earlier was minor because the first four days of hospitalization tend to be more profitable than subsequent days.
Hospitalists, who focus on inpatient care, are known to reduce costs and length of stay, but some hospitals cannot afford these medical specialists. This study, the first to use NPs for inpatient management, demonstrates that such use can result in earlier discharge of patients and lower hospital costs. The authors credit the success of the MDNP approach to teamwork, noting that "the impact of the daily multidisciplinary rounds on the outcomes of the study cannot be discounted."
Carol Potera
At the official opening of the Swaziland Wellness Centre for Health Care Workers in Manzini on September 28, Njabulo Mabuza, the minister of Health and Social Welfare, and Linda Carrier-Walker, of the International Council of Nurses (ICN), plant a tree in the garden.
The center, a project of the Swaziland Nurses Association (SNA), the ICN, the Danish Nurses Organization, the Stephen Lewis Foundation, and Becton, Dickinson, will provide health care services; education and training; and tuberculosis and HIV testing, counseling, and treatment to the kingdom's health care workers and their families. According to United Nations reports, Swaziland has one of the highest rates of adult HIV infection in the world-33%. Swaziland's nurses, burdened by overwhelming workloads, poor working conditions, and AIDS-often leave the country for better salaries and working conditions. The SNA intends for the center to help stem the loss. Similar centers are planned for Lesotho, Malawi, and Zambia.