title: Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost.
abstract: OBJECTIVE
  The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost.
  
  
  METHODS
  A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test.
  
  
  RESULTS
  The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37).
  
  
  CONCLUSIONS
  The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital.
  
  
  METHODS
  Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA; and †Emory University School of Medicine, Atlanta, GA.
authors.forename: Elise A
authors.initials: EA
authors.lastname: Hiza
authors.forename: Michael B
authors.initials: MB
authors.lastname: Gottschalk
authors.forename: Erica
authors.initials: E
authors.lastname: Umpierrez
authors.forename: Patricia
authors.initials: P
authors.lastname: Bush
authors.forename: William M
authors.initials: WM
authors.lastname: Reisman
mesh_terms: D003362:Cost-Benefit Analysis; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006282:Health Personnel / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000191:economics*; D009985:Orthopedics / Q000191:economics*; D064872:Patient Care Bundles / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*