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Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients

Bethea, Audis PharmD, BCPS, BCCCP; Samanta, Damayanti MS; White, Teresa APRN, FNP-BC; Payne, Nancy APRN, FNP-C; Hardway, Jessica APRN, FNP-C

doi: 10.1097/JTN.0000000000000445
RESEARCH
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Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending. The complexity of elderly trauma care and the need to evaluate the efficacy of management provided by NPs led to the development of the current study. Accordingly, this study endeavored to compare outcomes in elderly patients whose care was coordinated by trauma NP (TNP) versus nontrauma NP (NTNP) services. Patients under the care of TNPs had a 1.22-day shorter duration of hospitalization compared with that of the NTNP cohort (4.38 ± 3.54 vs. 5.60 ± 3.98, p = .048). Decreased length of stay in the TNP cohort resulted in an average decrease in hospital charges of $13,000 per admission ($38,053 ± $29,640.76 vs. $51,317.79 ± $34,756.83, p = .016). A significantly higher percentage of patients admitted to the TNP service were discharged home (67.1% vs. 36.0%, p = .002), and a significantly lower percentage of patients were discharged to skilled nursing facilities (25.7% vs. 51.9%, p = .040). These clinical and economic outcomes have proven beneficial in substantiating the care provided by TNPs at the study institution. Future research will focus on examining the association of positive outcomes with specific care elements routinely performed by the TNPs in the current practice model.

Center for Health Services and Outcomes Research (Dr Bethea and Ms Samanta), Charleston Area Medical Center (Mss White, Payne, and Hardway), Charleston, West Virginia.

Correspondence: Audis Bethea, PharmD, BCPS, BCCCP, West Virginia Clinical and Translational Science Institute, 3211 MacCorkle Ave SE, Charleston, WV 25304 (audis.bethea@camc.org).

The authors have no conflict of interest to report.

Copyright © 2019 by the Society of Trauma Nurses.