Critical Path Network

Research, collaboration makes successful NP model

Doctors involved in hiring process

When Chesapeake General Hospital began exploring ways to improve patient throughput and further reduce its length of stay, Roxana Ballinger, RN, BBA, CCM, director of care management, conducted research to discover what other hospitals had done to improve patient throughput and determined that nurse practitioners could play an important role in moving patients through the continuum.

"Studies show that there are a lot of benefits to having a nurse practitioner on the staff. We've seen nurse practitioners in private practice in physician offices for years. A nurse practitioner comes into the hospital and works with a physician group. We have a nurse practitioner in the emergency department but this is the first time we've had one in the case management department," she says.

The hospital targeted patients of physicians who want to remain in individual private practice and do not want to turn their patients over to a hospitalist.

"We looked at our general medicine doctors to determine how many patients they were bringing in and analyzed all their financial data and numbers for the entire fiscal year. Because these doctors are in private practice and they're in the office all day long, their utilization of services isn't optimal and management of their patients is much more difficult," she says.

The hospital looked at these physicians' length of stay, their volume on a monthly and yearly basis, the average direct cost per case, the indirect cost per case, profit-loss, and contribution margins for their patients.

"We compared the data we compiled on the physicians with the cost of a salary of an acute care nurse practitioner to see how it would benefit the hospital financially if we hired a nurse practitioner," she says.

For the initial nurse practitioner initiative, the hospital chose two doctors with the higher volume and whose patients had a higher average length of stay than similar patients.

The two physicians welcomed the program, Ballinger reports. "They thought it was great. They both have a longstanding history with the hospital and wanted to work with us to keep that relationship," she says.

The doctors were involved in the interview process along with Ballinger, the vice president of nursing, and representatives from care management and social work.

The hospital is tracking data on length of stay, volume, and cost and developing a patient satisfaction survey to rate the care the nurse practitioner provides. Ballinger expects the results to be positive.

"Overall, nurse practitioners result in better patient satisfaction and more continuity of care. When patients are seen by a nurse practitioner, they have fewer complications, fewer complaints about symptoms, and the overall quality of care improves," she adds.