title: The addition of a nurse practitioner to an inpatient surgical team results in improved use of resources.
abstract: BACKGROUND
  Resident work hour restrictions and changes in reimbursement may lead to an adverse effect on the continuity of care of a patient after discharge. This study analyzes whether adding a nurse practitioner (NP) to a busy inpatient surgery service would improve patient care after discharge.
  
  
  METHODS
  In 2007, a NP joined a team of 3 surgery attendings. She coordinated the discharge plan and communicated with patients after discharge. We reviewed the records of patients 1 year before (N = 415) and 1 year after (N = 411) the NP joined the team. The discharge courses of the patients were reviewed, and an unnecessary emergency room (ER) visit was defined as an ER visit that did not result in an inpatient admission.
  
  
  RESULTS
  The 2 groups were statistically similar with regard to age, race, acuity of the operation, duration of hospital stay, and hospital readmissions. Telephone communication between nurses and discharged patients was 846 calls before the NP and 1,319 calls after the NP, representing an increase of 64% (P < .0001). Visiting nurse, physical therapy, or occupational therapy services were rendered to only 25% of patients before the NP compared to 39% after (P < .0001). There were more unnecessary ER visits before the NP (103/415; 25%) compared to after (54/411; 13%) (P = .001).
  
  
  CONCLUSIONS
  Adding a NP to our inpatient surgery service led to an overall improvement in the use of resources and a 50% reduction in unnecessary ER visits. This study shows that the addition of a NP not only improves continuity of care on discharge but also has the potential to yield financial benefits for the hospital.
authors: Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
authors: Lourdes
authors: L
authors: Robles
authors: Michele
authors: M
authors: Slogoff
authors: Eva
authors: E
authors: Ladwig-Scott
authors: Dan
authors: D
authors: Zank
authors: Mary Kay
authors: MK
authors: Larson
authors: Gerard
authors: G
authors: Aranha
authors: Margo
authors: M
authors: Shoup
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D013502:General Surgery / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007087:Illinois; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000191:economics / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission; D012189:Retrospective Studies; D055815:Young Adult