Use of an NP Decreases Unneeded Emergency Department Visits

Emma Hitt, PhD

November 08, 2011

November 8, 2011 — The addition of a nurse practitioner (NP) to a surgical team cut the number of unnecessary emergency department visits in half and significantly increased the use of other services, such as home services and physical therapy, according to new research.

Margo Shoup, MD, from the Loyola University Medical Center in Maywood, Illinois, and colleagues published their findings in the October issue of Surgery.

According to the researchers, physician "extenders," such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week, as per a 2003 mandate. In September 2007, the Department of Surgery at Loyola University Medical Center hired an NP to aid in discharge planning and postoperative care for a team of 3 surgeons.

"The purpose of this study was to determine whether integrating this physician extender into the surgery team would have beneficial effects for both patient care and better resource allocation for the hospital," the authors note.

Dr. Shoup and colleagues compared the records of 415 patients seen in the year before the NP joined the staff with the records from 411 patients treated in the year after she joined the staff.

In the year before the NP, significantly more patients made unnecessary emergency department visits (103 of 415 [25%]) compared with after the NP had joined the team (54 of 411 [13%]; P = .001). The researchers defined unnecessary visits as those that did not result in an inpatient admission.

The NP communicated with patients and coordinated their discharge plan. Telephone conversations with patients increased by about two thirds during this time; in addition, use of visiting nurse, physical therapy, and occupational therapy services increased from 25% before the NP joined the department to 39% after.

"The major decrease in [emergency department] visits was due in large part to the communication I had with patients after they left the hospital," noted the NP involved in the study, Mary Kay Larson, BS, MSN, CNN, APRN-BC, in a written release. "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."

"Hospitals must continue to adapt to the changing health-care environment," Dr. Shoup saidin the release. "The addition of an [NP] 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."

The study was not commercially funded. The authors have disclosed no relevant financial relationships.

Surgery. 2011;150:711-717. Abstract