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

By Dale Russell, RN, MSN, ACNP-CS, Mary VorderBruegge, RN, MSN, ACNP-CS and Suzanne M. Burns, RN, MSN, RRT, ACNP-CS, CCRN.

• 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.

• Results No 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.

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