NP-led acute care teams improve inpatient care
NASHVILLE – Using an evidence-based framework to cast advanced practice registered nurses as leaders of interprofessional teams within acute care environments can improve the quality, safety and delivery of health care, according to researchers.
Pamela Jones, DNP, RN, NEA-BC, chief nursing officer and associate hospital director, and April N. Kapu, DNP, RN, ACNP-BC, assistant director of advanced practice nursing and critical care, both of Vanderbilt University Hospital in Nashville, Tenn., examined outcomes associated with a proof of concept intervention known as Vanderbilt Anticipatory Care Teams (vACT). They described the project at the American Association of Nurse Practitioners 2014 meeting.
“The project was about creating a fully functional team with an NP functioning as the leader of unit-based teams,” Jones explained. “The function of that NP working with a full acute care team -- including nurses, physicians, physical therapists -- was taking an active role as the leader of that team and focusing primarily on the needs of the patients and families as defined by a really structured process.”
The investigators used structural empowerment theory to clarify team members' roles, increase communication, efficiency and reliability, along with a dynamic risk profile to anticipate patient care needs. Detailed workflow maps were created at the time of vACT unit implementation.
“We divided the teams that took care of the patients so there was the primary team, a dynamic care team that would come in and focus on a particular aspect of patient care, and then there was the unit based team,” Kapu explained.
They then performed a retrospective secondary analysis of seven inpatient NP-led anticipatory teams to determine the impact on patients' average length of stay and quality outcomes associated with cost avoidance.
“We were able to show decreased length of stay, decreased complications and a decrease in readmissions as a result of teams that were put into place with structural empowerment,” Kapu said.
The benefits of adding NPs to inpatient care teams are their ability to provide care according to a protocol and manage the full needs of the patient, according to Jones.
“NPs are very attuned to not only the physiological needs of the patient, but the psychosocial needs of those patients as well,” she said.”They really do a great job of coordinating all of the care and working with all of the other team members to provide care in an effective manner.”
Both Jones and Kapu emphasized the importance of individualizing such interventions by looking at the needs of the patients and their families and identifying which are not being met by existing care teams.
“Nurse practitioners can fulfill an excellent role with both their clinical skills and the concept of care coordination and holistic care,” Jones concluded. “I would work individually with those providers to determine what the need s are of the specific population and then get the right nurse practitioner in the right place to meet the needs of the patient and family.”