title: Cardiac acute care nurse practitioner and 30-day readmission.
abstract: BACKGROUND
  The utilization outcomes of nurse practitioners (NPs) in the acute care setting have not been widely studied.
  
  
  OBJECTIVE
  The purpose of this study was to determine the impact on utilization outcomes of NPs on medical teams who take care of patients admitted to a cardiovascular intensive care unit.
  
  
  METHODS
  A retrospective 2-group comparative design was used to evaluate the outcomes of 185 patients with ST- or non ST-segment elevation myocardial infarction or heart failure who were admitted to a cardiovascular intensive care unit in an urban medical center. Patients received care from a medical team that included a cardiac acute care NP (n = 109) or medical team alone (n = 76). Patient history, cardiac assessment, medical interventions, discharge disposition, discharge time, and 3 utilization outcomes (ie, length of stay, 30-day readmission, and time of discharge) were compared between the 2 treatment groups. Logistic regression was used to identify predictors of 30-day readmission.
  
  
  RESULTS
  Patients receiving care from a medical team that included an NP were rehospitalized approximately 50% less often compared with those receiving care from a medical team without an NP. Thirty-day hospital readmission (P = .011) and 30-day return rates to the emergency department (P = .021) were significantly lower in the intervention group. Significant predictors for rehospitalization included diagnosis of heart failure versus myocardial infarction (odds ratio [OR], 3.153, P = 0.005), treatment by a medical team without NP involvement (OR, 2.905, P = 0.008), and history of diabetes (OR, 2.310, P = 0.032).
  
  
  CONCLUSIONS
  The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.
authors.affiliation: Daniel David, BSN, MS, RN Jonas Foundation Scholar, Northeastern University, Bouve College of Health Sciences, School of Nursing, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. Lorraine Britting, BSN, MS, NP-C, SFHM Clinical Manager of Nurse Practitioners, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Joanne Dalton, PhD, RN, PHCNS-BC Beth Israel Deaconess Medical Center Nurse Scientist, Associate Professor, School of Nursing, Sciences, and Health Professions, Regis College, Weston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: David
authors.forename: Lorraine
authors.initials: L
authors.lastname: Britting
authors.forename: Joanne
authors.initials: J
authors.lastname: Dalton
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001900:Boston; D064646:Cardiovascular Nursing; D064648:Critical Care Nursing; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D009722:Nurse Practitioners; D024802:Nurse's Role; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population