The drop in recidivism went beyond the initial 30-day discharge period. The 60-day and 90-day readmission rates for the group receiving care through the model were 4% and 3% compared to 27% and 29% in a group receiving typical care.
Because of these significant results, the model has expanded beyond heart failure patients, and advanced practice providers are being added to more of the medical center’s service lines, including cardiology, chronic care management, oncology, and genetics. Presently, there are approximately 40 advanced practice providers (including PAs) at Holy Name, up from five in 2009.
Sheryl Slonim, DNP, RN-BC, NEA-BC, APN-C, executive vice president, patient care services and chief nursing officer at Holy Name says her vision is to continue to expand the number and use of APNs at the organization.
"You can’t function in a silo anymore. Care must be managed and coordinated across the continuum, and who better than the APN to help coordinate that?" she says. "What I don’t think people realize are the many different roles and areas where APNs can function. Whether it’s in the home, whether it’s in the community, whether it’s in the hospital, whether it’s in long-term care, whether it’s in subacute, whether it’s in a surgery center, there are so many different roles that the APN can play in so many different environments. Why not take advantage of the role and allow it to help foster the healthcare system that right now is just so confusing to people?"
APRNs at CHI have also delivered strong results in terms of patient outcomes, Edwards says.
In the organization’s Nebraska division, an NP-run program in skilled nursing facilities has grown from three NPs to nine over the past 11 years. Working in collaboration with a physician, the NPs see more than 2,000 unique patients a year, up from 300 when it began. The readmission rates for patients in the program are around 12%, double digits lower than the national hospital readmission rates of 25%.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.