The Nurse Practitioner Role: The Communication Link for Cardiac Surgery Patients

Cardiac acute care nurse practitioner and 30-day readmission

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.

Core competencies required for the cardiac surgical nurse practitioner

PURPOSE

To propose a set of core competencies for the cardiac surgery nurse practitioner (CSNP).

DATA SOURCES

Research, review articles, standards of practice, hospital practice guidelines.

CONCLUSION

Although there have been preliminary studies that demonstrate the effectiveness and cost savings associated with the use of a CSNP, specific competencies have yet to be defined. The CSNP provides direct patient care and functions simultaneously as part of an interdisciplinary team. The CSNP cares for the patient from preadmission until postdischarge. The CSNP facilitates the transfer of information along the transitions of care that is vital to positive patient outcomes.

IMPLICATIONS FOR PRACTICE

Changes in health care have forced providers to find ways to decrease the cost of services while maintaining high-quality, efficient care for their patients. In addition, there is a rising acuity of the patient population admitted for cardiac surgery. The continued development of the role of the CSNP and evidence that supports the cost savings and improved patient outcomes that result from the use of CSNPs will encourage more and more cardiac surgery programs to use CSNPs along the continuum of care.

The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses

Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations.