Compared with usual care, a multidisciplinary team of hospitalist/attending physicians and advance practice nurses coupled with daily instead of weekly multidisciplinary rounds improved the management of general medicine patients in a large medical center during hospital stays and for 30 days after discharge. This team approach reduced length of hospital stay and costs without affecting hospital readmissions, mortality, or compromising quality of life and patient satisfaction, according to a recent study supported by the Agency for Healthcare Research and Quality (HS10734).
Marie J. Cowan, Ph.D., of the University of California, Los Angeles School of Nursing, and her colleagues examined the impact of the Multidisciplinary, Doctor, Nurse Practitioner (MDNP) intervention on length of stay, hospital costs, resource use for 4 months after discharge, readmissions, and other outcomes. They assigned 581 general medical patients to the experimental (E) group and 626 similar patients to the control (usual care, C) group.
The primary duties of the nurse practitioners (NPs) in the E group were case management, facilitation of communication and collaboration with physicians and nurses, leading and implementing timely processes of care after the daily multidisciplinary rounds, surveillance of cost-effective measures, and facilitation of continuity of care between inpatient and outpatient management and for 30 days after discharge.
A hospitalist was medical director of the E group, and attending physicians randomized to the E group were instructed personally by the hospitalist medical director to perform their duties as would a hospitalist. Their duties included daily multidisciplinary rounds, twice-daily assessment of patients' clinical status, use of clinical pathways, and other duties. The hospitalist medical director wrote disease-specific pathways for various conditions, met with NPs weekly, and was always available to them by phone.
Patients in the E group had significantly shorter hospital stays than those in the C group. After adjustment for the cost of the team intervention (mostly for NP salaries), a significant net cost savings per patient was associated with the intervention. There were no significant differences in readmission rates or mortality between the two groups. Because health outcomes and patient satisfaction were comparable for the two groups, the intervention was considered cost effective.
See "Hallmarks of quality: Generating and using knowledge," by Dr. Cowan, in Communicating Nursing Research 37(1), pp. 3-12, 2004.
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