Effect of an Outcomes-Managed Approach to Care of Neuroscience Patients by Acute Care Nurse Practitioners

2002 ◽  
Vol 11 (4) ◽  
pp. 353-362 ◽  
Author(s):  
Dale Russell ◽  
Mary VorderBruegge ◽  
Suzanne M. Burns
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Foley Catheter ◽  
Baseline Data ◽  
Care Nurse ◽  
Financial Outcomes

• 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. • ResultsNo 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 $2 467 328. • 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.

Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit

2005 ◽  
Vol 14 (2) ◽  
pp. 121-130 ◽  
Author(s):  
Leslie A. Hoffman ◽  
Frederick J. Tasota ◽  
Thomas G. Zullo ◽  
Carmella Scharfenberg ◽  
Michael P. Donahoe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Intensive Care Unit ◽  
Care Nurse ◽  
Medical Intensive Care ◽  
Acute Care Nurse Practitioner ◽  
Attending Physician

• Background Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.• Objective To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.• Methods During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.• Results Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).• Conclusions In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

scholarly journals Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence

2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Perception Of Support ◽  
Evidence Based Care

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training

2003 ◽  
Vol 12 (5) ◽  
pp. 436-443 ◽  
Author(s):  
Leslie A. Hoffman ◽  
Frederick J. Tasota ◽  
Carmella Scharfenberg ◽  
Thomas G. Zullo ◽  
Michael P. Donahoe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Nurse Practitioner ◽  
Similar Proportion ◽  
Coordination Of Care ◽  
Care Nurse ◽  
Training Requirements ◽  
Work Sampling ◽  
Acute Care Nurse Practitioner

• Background Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients’ outcomes.• Objective To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients’ care in a step-down medical intensive care unit.• Methods Work sampling techniques were used to collect data when the nurse practitioner had 6 months’ or less experience in the role (T1), after the nurse practitioner had 12 months’ experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities.• Results Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001).• Conclusion The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients’ families and collaborating with health team members.

Implementation of a Medical Intensive Care Unit Acute-Care Nurse Practitioner Service

2011 ◽  
Vol 39 (2) ◽  
pp. 32-39 ◽  
Author(s):  
Janna S. Landsperger ◽  
Kristina Jill Williams ◽  
Susan M. Hellervik ◽  
Cherry B. Chassan ◽  
Lisa N. Flemmons ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Nurse Practitioner ◽  
Medical Intensive Care Unit ◽  
Care Nurse ◽  
Medical Intensive Care ◽  
Acute Care Nurse Practitioner

Acute care nurse practitioner curriculum: content and development process

1995 ◽  
Vol 4 (3) ◽  
pp. 179-188 ◽  
Author(s):  
M Hravnak ◽  
SN Kobert ◽  
KG Risco ◽  
M Baldisseri ◽  
LA Hoffman ◽  
...  
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Clinical Education ◽  
Multidisciplinary Approach ◽  
Care Delivery ◽  
Healthcare Team ◽  
Care Nurse ◽  
Acute Care Nurse Practitioner ◽  
Current Guidelines

Curriculum development for preparation of acute care nurse practitioners requires a comprehensive process. To develop a program for their preparation at a large university, the faculty examined needs of the target patient population and care delivery system; scope of acute care nurse practitioner practice; current guidelines for the education of primary care nurse practitioners; evolving guidelines for the didactic and clinical education of acute care nurse practitioners; educational requirements of governing or licensing and certifying bodies; and placement of this new role within the existing healthcare team structure. A curriculum was then developed using a collaborative, multidisciplinary approach.

scholarly journals Intensive Care Unit and Acute Care Unit Length of Stay After Congenital Heart Surgery

2020 ◽  
Vol 110 (4) ◽  
pp. 1396-1403 ◽  
Author(s):  
Stephen A. Hart ◽  
Ronn E. Tanel ◽  
Alaina K. Kipps ◽  
Amanda K. Hoerst ◽  
Margaret A. Graupe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Acute Care ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Unit Length ◽  
Congenital Heart Surgery ◽  
Acute Care Unit
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