title: Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction.
abstract: BACKGROUND
  The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program.
  
  
  METHODS
  LOS data from December 1, 2011 through December 1, 2012 was compared with data from the same months from the previous two years and estimated hospital charges and patient days were extrapolated. Physician and nursing surveys were performed. Data from 2010 (n = 2,559) and 2011 (n= 2,671) were averaged and the mean LOS for the entire trauma service was 7.2 days. After adding an experienced ACNP, the average LOS decreased to 6.4 days, a 0.8 day reduction. Per patient, there was a $ 9,111.50 savings in hospital charges, for a reduction of $27.8 million dollars in hospital charges over the 12 month pilot program.
  
  
  RESULTS
  A confidential survey administered to attending physicians showed that 100% agreed that a nurse practitioner in the stepdown area was beneficial and helped throughput. Dayshift nurses were surveyed, and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the patient's plan of care, experienced in the care of trauma patients, and improved patient care overall.
  
  
  CONCLUSIONS
  The addition of experienced ACNPs resulted in the decrease of overall trauma service LOS, saving almost $9 million in hospital charges.
  
  
  METHODS
  Economic/decision study, level III.
authors.affiliation: From the Division of Trauma and Surgical Critical Care (N.C., R.Mi., R.Ma., M.M., M.F., S.A., B.E., L.W.), and Advanced Practice Nursing (A.K.), Division of Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Nina
authors.initials: N
authors.lastname: Collins
authors.forename: Richard
authors.initials: R
authors.lastname: Miller
authors.forename: April
authors.initials: A
authors.lastname: Kapu
authors.forename: Rita
authors.initials: R
authors.lastname: Martin
authors.forename: Melissa
authors.initials: M
authors.lastname: Morton
authors.forename: Mary
authors.initials: M
authors.lastname: Forrester
authors.forename: Shelley
authors.initials: S
authors.lastname: Atkinson
authors.forename: Bethany
authors.initials: B
authors.lastname: Evans
authors.forename: Linda
authors.initials: L
authors.lastname: Wilkinson
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D004635:Emergency Medicine; D016529:Emergency Nursing; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007588:Job Satisfaction; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D009722:Nurse Practitioners / Q000191:economics / Q000600:supply & distribution*; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010549:Personal Satisfaction; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014193:Trauma Centers / Q000458:organization & administration*; D000078329:Workforce