Based on evidence, CHI made a commitment to strengthen advanced practice across the organization, including hiring Michelle L. Edwards, DNP, APRN, FNP, ACNP, FAANP, as system vice president, advanced practice.
"We want to use more advanced practice practitioners. We want to move into a team care model because everything we looked at said that was where we needed to go if we were truly going to keep people well, as well as take care of them in the hospital, across the care continuum, and as populations," Sanford says.
CHI isn’t alone in recognizing how valuable APRNs can be in affecting clinical, quality, and financial outcomes. Organizations around the country are also increasing their use of APRNs, and some are already seeing quality outcomes improve as a result.
Improved readmission rates
A few years ago, Judith Kutzleb, RN, DNP, CCRN, CCA, APN-C, vice president of advanced practice professionals at Holy Name Medical Center was given carte blanche to design a new nursing care model at the organization, a private nonprofit 361-bed acute care hospital in Teaneck, New Jersey. After working with a subcommittee of APNs, she launched the NP Care Model in 2012, a patient-centered collaborative care model.
"The nurse practitioner is the conduit throughout the disciplines in order to make the patient experience and outcomes the very best, and that’s basically how we designed the model. Then we looked at the framework of complementary responsibilities that an APN possesses and what would bring relevance to the program such as, 'What are the opportunities for the physician? What would be the organizational benefit? And is there a return on investment?' " Kutzleb says.
The model’s goals were threefold: Reduce 30-day readmissions by 11% over 12 months, decrease cost per case, and enhance quality patient outcomes through NP-directed patient education on disease self-management.
The program, which originally focused on heart failure patients, far surpassed these initial goals. Over a 12-month period, 30-day readmission rates dropped to 8% from 26%. Healthcare costs for the group of 312 patients receiving care via the NP Care Model was $311,818 during the 30 days after discharge. Prior to its implementation, cost of care for this patient population during the 30 days postdischarge was $1,019,405.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.