Expanding the Role of an Acute Care Nurse Practitioner to Improve Patient Throughput and Decrease Length of Stay

Purpose:
We hypothesized that adding experienced Trauma Acute Care Nurse Practitioners (ACNP) to a previously housestaff-only area, the Trauma Stepdown unit, would improve throughput, thereby decreasing length of stay and hospital charges.

Significance:
The VUMC Trauma service experienced preventable delays in moving patients through their hospital course. Furthermore, bedside nurses expressed the need to have a consistently accessible provider for consultation and coordination of each patient's plan of care.

Strategy and Implementation:
Methods: Using the data collected from Medipac tables in Vanderbilt's enterprise data warehouse, we compared LOS data from December 1, 2011 through February 29, 2012 to data from the same months from the previous two years and extrapolated hospital charges and patient days. We conducted physician and nursing surveys using REDCap electronic data capture tools hosted at our institution. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies. For December 2009-February 2010 (468 cases) and December 2010-February 2011 (479 cases), the average LOS on the Trauma Surgery Service was 6.8 days and 6.5 days respectively. After the addition of an experienced ACNP, the average LOS during December 1, 2011 through February 29, 2012 (583 cases), decreased to 6.0 days. This translates into a significant reduction in hospital charges, for a total savings of $2,714,448.00 in total hospital charges over the three month period.

Evaluation:
The dayshift RNs were surveyed and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the plan of care. 100% of RNs felt that normalization of the patient was improved and pain was better controlled. 96% of the nurses felt that patients were better informed of the plan of care.

Implications for Practice:
After, the the expansion of the ACNP role, the overall trauma service length of stay was significantly decreased, saving over 2.7 million dollars in hospital charges. This allows for increased capacity, decreased costs, increased revenue, improved staff satisfaction, and improved throughput.