Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.

OBJECTIVE: To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers. METHODS: Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients. RESULTS: No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328. CONCLUSIONS: Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.