Outcomes of Adding Nurse Practitioners to Interprofessional Teams Utilizing Structural Empowerment Theory

Purpose:
With optimal organizational structure, NPs can decrease healthcare costs with acute transition management, decreasing length of stay and with adherence to clinical practice guidelines, reducing complications associated with fragmented, unstandardized care.

Significance:
ACNPs practicing at the top of their license can be a valuable resource in the inpatient setting. Current healthcare initiatives have created the optimal environment for NPs to showcase their abilities and contributions.

Strategy and Implementation:
We hypothesized that through organizational application of Structural Empowerment theory, we could integrate acute care NPs into interprofessional models of care, with a subsequent increase in revenue and reduction in costs via quality improvement.With NPs added to the adult critical care units and hospitalist teams, we tracked revenue and NP associated quality metrics.From July 1, 2011 – June 30, 2012, we tracked NP charges and collections for 4 adult intensive care units (ICU),and 1 hospitalist NP team. We developed practice specific electronic progress note templates to chart daily notes and collect quality data which was then transferred to an electronic dashboard.From January 2011-Dec. 2011, we added NPs to RRT and collected data via a secure electronic data capture tool, REDCap. For a 6-month pilot,Dec.2011 - Feb. 2012, of adding NP hospitalists to a trauma stepdown unit,we collected length of stay data utilizing ADT tracking software and compared to 2 years prior.

Evaluation:
The gross collections met 52%(FY11) and 88%(Fy12) of salary and fringe expenses for four ICUs. After addition of NPs to RRT in 2011, the ratio of rapid response to codes was 18%, as opposed to 35% in 2010. Adding hospitalists NPs showed high staff satisfaction and a 1.0 reduction in LOS in 1 yr.

Implications for Practice:
These studies demonstrate the value of adding ACNPs to inpatient models of care. ACNPs as billing providers can generate revenue, avoid costs associated with hospital complications and save costs with decreased length of stay.