Acute Care/Hospitalization

Collaboration of hospitalists/attending physicians and nurse practitioners can reduce hospital stays and increase profit

A multidisciplinary team of hospitalist/ nonhospitalist attending physicians and nurse practitioners (NPs) can reduce hospital length of stay (LOS) and increase hospital profits when compared with usual care only. This approach reduced the average LOS from 6 to 5 days. By reducing the number of hospital days after the first 4 days, which are the most profitable ones, hospital profits increased by $1,591 per day for each patient without increasing hospital readmission or mortality rates.

Previous studies have demonstrated reduced hospital costs and LOS with use of hospitalists. However, in many places, it is not feasible to have full-time hospitalists at the bedside and nonhospitalist attending physicians in academic medical centers do not spend as much time as hospitalists in inpatient care. In a study supported by the Agency for Healthcare Research and Quality (HS10734), Marie J. Cowan, Ph.D., R.N., F.A.A.N., and colleagues used NPs to supplement physicians' efforts to ensure continuity of care. They compared this approach for managing 581 general medicine patients in 1 unit of a large academic medical center during hospitalization and for 30 days after discharge with usual care for 626 patients in another general medicine unit.

The hospitalist medical director educated attending physicians about hospitalist duties and in-serviced and guided NPs on the experimental unit. The director also wrote protocols for specific diseases and care processes for the NPs to follow. The usual care unit had multidisciplinary rounds for 90 minutes once a week compared with daily rounds for the experimental unit, which also included post-discharge home visits and/or phone calls by the NPs. The researchers caution that the impact of the daily (vs. weekly) multidisciplinary rounds on the outcomes of the study cannot be discounted.

More details are in "The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs," by Dr. Cowan, Martin Shapiro, Ph.D., M.D., Ron D. Hays, Ph.D., and others, in the February 2006 Journal of Nursing Administration 36(2), pp. 79-85.

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