Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.
OBJECTIVE
To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers.


METHODS
Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients.


RESULTS
No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328.


CONCLUSIONS
Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.
Russell
Dale
D
Neuroscience Service Center, University of Virginia Health System, Charlottesville, USA.
VorderBruegge
Mary
M
Burns
Suzanne M
SM
D000293:Adolescent; D000328:Adult; D019090:Case Management / Q000191:economics; D019317:Evidence-Based Medicine; D005260:Female; D006302:Health Services Research; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics / Q000451:nursing*; D009722:Nurse Practitioners; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome; D014768:Virginia