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BACKGROUND: The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program. METHODS: LOS data from December 1, 2011 through December 1, 2012 was compared with data from the same months from the previous two years and estimated hospital charges and patient days were extrapolated. Physician and nursing surveys were performed. Data from 2010 (n = 2,559) and 2011 (n= 2,671) were averaged and the mean LOS for the entire trauma service was 7.2 days. After adding an experienced ACNP, the average LOS decreased to 6.4 days, a 0.8 day reduction. Per patient, there was a $ 9,111.50 savings in hospital charges, for a reduction of $27.8 million dollars in hospital charges over the 12 month pilot program. RESULTS: A confidential survey administered to attending physicians showed that 100% agreed that a nurse practitioner in the stepdown area was beneficial and helped throughput. Dayshift nurses were surveyed, and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the patient's plan of care, experienced in the care of trauma patients, and improved patient care overall. CONCLUSION: The addition of experienced ACNPs resulted in the decrease of overall trauma service LOS, saving almost $9 million in hospital charges

Interdisciplinary Teamwork article

Interdisciplinary team work is a complex process in which different types of staff work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education [ 1], there is little evidence as to the most effective way of delivering interdisciplinary team work [ 2].

Interdisciplinary team work is a complex process in which different types of staff work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education [ 1], there is little evidence as to the most effective way of delivering interdisciplinary team work [ 2].

This article reviewed several different studies on interdisciplinary care and looked for ways that we can improve on health care and implement better teamwork. What I found most interesting is that the article talks about how educating staff on the benefits of teamwork is seriously lacking. Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care.

This article finds two emerging issues that must be addressed to optimize patient care: "the need for specialized health professionals, and the need for these professionals to collaborate." In nursing we talk a lot about "continuity of care" and that a seamless transition between PCPs, specialists, in-patient, and out-patient services is not only good-practice but vital for thorough health care delivery and improving long term outcomes.

The role of APRNs continues to expand when current gaps in patient care management and outcomes are identified. Central Arkansas Veteran Healthcare System created the role of Abnormal Radiology Findings APRN with the aim of improving patient outcomes by decreasing the length of time between abnormal radiology findings and decrease of care for our veterans. During the year of research since the advent of this position, the days until decision dropped on average from 38 to 7 demonstrating the efficacy of the role and the ways APRN are well placed within the health care system to provide patient-centered care.

This article asks the question: "Compared to other providers (physicians or teams without APRNs), are APRN patient outcomes of care similar?" The study is specific to USA and includes data regarding NPs, CNRAs, and CNMs. Outcomes were determined by the following: patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status, blood glucose, serum lipids, blood pressure, emergency department visits, hospitalization, duration of ventilation, length of stay, and mortality (p9).

This article discusses how overall outcomes are better for patients when ACNP are members of a unit or service-based provider team. It also touches on how to hire ACNP for different patient populations.

This article talks about keeping a personal relationship between patients, families, communities and primary care providers.When caregivers, patients, and sometimes family caregivers meet, it offers the whole group an opportunity to share useful educational information with patients and families in both static and dynamic ways.

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The following is the abstract as stated by the author: "Purpose: To describe factors that ensure a smooth transition from nurse practitioner (NP) student to independent NP during the first year of practice. Data sources: Two contrasting case examples, the authors' experiences, and selected professional literature. Conclusions: Key points to consider upon searching or taking a first NP job include patient, colleague, and clinic factors. Patient factors include mix of patient presentations, complexity of patient presentations, insurance status, and population. Colleague factors include mentorship, charting, mix of providers, and availability of providers. Perhaps most importantly, clinic factors include productivity expectations, practice mission, charting systems, on-call requirements, supervision of other staff, and teaching status. Together, these factors can largely determine whether an NP's days are satisfying or frustrating in a new job. Implications for practice: The transition from NP student to independent NP can be daunting. Although nursing schools and practice sites have responsibilities to ensure the transition is smooth, the new NP is ultimately responsible for the transition. [ABSTRACT FROM AUTHOR]"

This article discusses how the interdisciplinary team improves the care experience, specifically in the dying critically ill patient

I found this article to be very interesting in that it highlights the importance of transitioning and caring for the geriatric population. As part of my AGACNP program and future career i will be working with many elderly patients.

Article showing an application of teamwork in a primary care setting to develop a behavior health intervention. See the abstract below! J Am Board Fam Med. 2015 Sep-Oct;28 Suppl 1:S21-31. doi: 10.3122/jabfm.2015.S1.150042. Abstract PURPOSE: This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. METHODS: This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States. RESULTS: Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. CONCLUSION: Primary care and behavioral health clinicians, through their interactions, c

Created October 28, 2007 by Sarah M. Lawrence and Michael O'Brien Health care is an increasingly diverse field where many specialties interact to provide patient care. The team approach to caring for patients includes many professionals performing a variety of specialized functions designed to meet the physical, emotional and psychological needs of the patient.

The author figures out the challenges in interdisciplinary teamwork among healthcare providers. These challenges are worth attention if we hope to do well in interdisciplinary teamwork.

This article discusses how interdisciplinary teamwork is experienced at three levels: healthcare professionals, patients, and healthcare organizations.

The points made by the author - reaching decisions collectively, making sure everyone is committed to the same purpose and goal, full participation, understanding the work of other disciplines - can be applied in any type of teamwork setting for successful outcomes. However, with healthcare the author points out that effective teamwork can lead to decreasing health care costs, improved patient safety, and decreasing workload through shared responsibilities. All areas that can allow for better patient care and more efficient use of time and financial resources.

This article discusses the benefits and pit-falls to autonomous primary care Nurse practitioner practice and advocates for cost effective improvements to our healthcare system. The research suggests that Nurse practitioners who practice independently report greater job satisfaction, improved patient outcomes and provide low cost, high quality services that are equal or superior to primary care physicians. Unfortunately, current healthcare reimbursement models, policies and reluctant physicians have created barriers to autonomous NP practices. The author suggests that autonomous practice requires further research across the U.S, the establishment of a well-defined model and the evaluation of patient outcomes, in order to determine whether the present day Nurse Practitioner requires future collaborative agreements with physicians, in order to provide quality patient care across the United States.

This systematic literature search article is in two parts: deinition and application of telehealth for APRNs and describes an approach for telehealth training for APRNs. APRNs can utilize telehealth technologies to improve patient access to care with cost-saving measures, collaborate with other disciplines, and remote patient monitoring. Students need to become competent and skilled with the evolving technologies and regulations to improve patient outcomes with limited resources to healthcare.

When nurses, physicians and other health professionals overcome professional barriers and work together, patients--and provider--benefit.

Meant to share this when we did our timelines. This was cited as a pinnacle article for the NP profession. It demonstrates that NPs give just as effective care as physicians in a primary care setting when given equal authority and responsibility. Research from JAMA - Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians - A Randomized Trial - ContextStudies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians.

Landmark article showing primary care from NP vs MD was not different.