David Daniel, Britting Lorraine, Dalton Joanne
Daniel David, BSN, MS, RN Jonas Foundation Scholar, Northeastern University, Bouve College of Health Sciences, School of Nursing, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. Lorraine Britting, BSN, MS, NP-C, SFHM Clinical Manager of Nurse Practitioners, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Joanne Dalton, PhD, RN, PHCNS-BC Beth Israel Deaconess Medical Center Nurse Scientist, Associate Professor, School of Nursing, Sciences, and Health Professions, Regis College, Weston, Massachusetts.
J Cardiovasc Nurs. 2015 May-Jun;30(3):248-55. doi: 10.1097/JCN.0000000000000147.
The utilization outcomes of nurse practitioners (NPs) in the acute care setting have not been widely studied.
The purpose of this study was to determine the impact on utilization outcomes of NPs on medical teams who take care of patients admitted to a cardiovascular intensive care unit.
A retrospective 2-group comparative design was used to evaluate the outcomes of 185 patients with ST- or non ST-segment elevation myocardial infarction or heart failure who were admitted to a cardiovascular intensive care unit in an urban medical center. Patients received care from a medical team that included a cardiac acute care NP (n = 109) or medical team alone (n = 76). Patient history, cardiac assessment, medical interventions, discharge disposition, discharge time, and 3 utilization outcomes (ie, length of stay, 30-day readmission, and time of discharge) were compared between the 2 treatment groups. Logistic regression was used to identify predictors of 30-day readmission.
Patients receiving care from a medical team that included an NP were rehospitalized approximately 50% less often compared with those receiving care from a medical team without an NP. Thirty-day hospital readmission (P = .011) and 30-day return rates to the emergency department (P = .021) were significantly lower in the intervention group. Significant predictors for rehospitalization included diagnosis of heart failure versus myocardial infarction (odds ratio [OR], 3.153, P = 0.005), treatment by a medical team without NP involvement (OR, 2.905, P = 0.008), and history of diabetes (OR, 2.310, P = 0.032).
The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.
执业护士（NP）在急性护理环境中的使用效果尚未得到广泛研究。
本研究的目的是确定NP对负责心血管重症监护病房收治患者的医疗团队使用效果的影响。
采用回顾性两组比较设计，评估185例ST段或非ST段抬高型心肌梗死或心力衰竭患者的治疗效果，这些患者被收治于一家城市医疗中心的心血管重症监护病房。患者接受了包括心脏急性护理NP的医疗团队（n = 109）或仅医疗团队（n = 76）的护理。比较了两个治疗组之间的患者病史、心脏评估、医疗干预、出院处置、出院时间和3个使用效果指标（即住院时间、30天再入院率和出院时间）。采用逻辑回归分析确定30天再入院的预测因素。
与接受无NP医疗团队护理的患者相比，接受包括NP的医疗团队护理的患者再次住院的频率约低50%。干预组的30天住院再入院率（P = 0.011）和30天急诊复诊率（P = 0.021）显著更低。再住院的显著预测因素包括心力衰竭与心肌梗死的诊断（比值比[OR]，3.153，P = 0.005）、无NP参与的医疗团队治疗（OR，2.905，P = 0.008）和糖尿病病史（OR，2.310，P = 0.032）。
在照顾心肌梗死和心力衰竭患者的医疗团队中增加心脏急性护理NP对30天急诊复诊率和住院再入院率有积极影响。
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