Center for Health Services and Outcomes Research (Ms Samanta), Charleston Area Medical Center (Dr Hardway and Ms Evans), Charleston, West Virginia; and Good Samaritan Hospital, UK HealthCare, Lexington, Kentucky (Dr Bethea).
J Trauma Nurs. 2020 May/Jun;27(3):163-169. doi: 10.1097/JTN.0000000000000506.
The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews of nonsurgical admissions when rates of allocation to this service exceed 10% of all inpatient traumas. Nonsurgical admission rates at the study institution, which is a Level I trauma center, historically exceeded this ACS criterion. In an effort to decrease nonsurgical admissions, the study institution recruited trauma nurse practitioners (TNPs) who began managing low acuity patients with oversight from trauma attending physicians. This study examines the impact of TNPs on the rate of nonsurgical admissions. A retrospective cohort study was conducted with 1,400 patients between January 2017 and October 2018. Two cohorts examined in this study included trauma patients whose care was managed by the TNPs versus those admitted under the care of hospitalists. The rate of admission to nonsurgical services (NSS) was 19.6% in 2017 and 13.9% in 2018, which yielded a significant decrease from previous years' percentages (p < .001). The average hospital length of stay was 1.17 days shorter in the TNP group, which translated into a savings of approximately $876,330 in hospital charges for the study period. Additional significant findings noted in favor of the TNP cohort were for discharge orders placed prior to noon, discharge location, and reduced time to the operating room. This TNP model proved to be successful in significantly reducing admissions to NSS and substantiated the quality of patient care provided by TNPs. Hospitals struggling to meet the ACS criterion for NSS admissions may consider implementing a similar TNP model.
美国外科医师学院 (ACS) 要求所有创伤中心在非手术入院率超过所有住院创伤患者的 10%时，对非手术入院患者进行个体病例回顾。作为一级创伤中心的研究机构，其非手术入院率历来超过 ACS 的这一标准。为了降低非手术入院率，研究机构招募了创伤护士从业者 (TNP)，他们在创伤主治医生的监督下开始管理低危患者。本研究考察了 TNP 对非手术入院率的影响。这项回顾性队列研究纳入了 2017 年 1 月至 2018 年 10 月期间的 1400 名患者。本研究检查了两个队列，包括由 TNP 管理的创伤患者和由医院医生管理的入院患者。2017 年和 2018 年非手术服务（NSS）的入院率分别为 19.6%和 13.9%，与前几年的百分比相比有显著下降（p<0.001）。TNP 组的平均住院时间缩短了 1.17 天，这在研究期间为医院费用节省了约 876330 美元。TNP 组的其他显著发现是提前至中午下达出院医嘱、出院地点和减少到手术室的时间。这种 TNP 模式在显著降低 NSS 入院率方面取得了成功，并证实了 TNP 提供的患者护理质量。那些努力达到 ACS 对 NSS 入院率标准的医院可以考虑实施类似的 TNP 模式。
