Adding a nurse practitioner (NP) to a resident physician team improves the efficiency of the discharge process but does nothing to decrease readmissions, according to a study in this month's Journal of Hospital Medicine.
In a randomized controlled trial at Massachusetts General Hospital (MGH) in Boston, NP use resulted in more discharge summaries completed within 24 hours when compared to a control group (67% vs 47%, P<0.001), according to the report, "Improving the Discharge Process by Embedding a Discharge Facilitator in a Resident Team." The study reported more follow-up appointments scheduled (62% vs. 36%, P<0.0001) scheduled and better attendance at those appointments within two weeks (36% vs. 23%, P<0.0002).
But for all the benefits, study author Kathleen Finn MD, MPhil, FACP, FHM, expresses disappointment in the fact that there was no significant difference between the groups in 30-day ED visits or 30-day readmissions.
"The literature suggests if we improve the discharge process, make it safer, and make sure patients have appropriate follow-ups in a timely fashion, we should be able to reduce readmissions," she says. "When we took a general medical population and did all that, we didn't get those results. However, its a single study, with one nurse, so its hard to say. But that was a little disappointing."
The study's results were enough to prompt the expansion of the program from one resident team to three. In the long term, Dr. Finn wants physician educators who are interested in limiting work hours and admissions to view the discharge process as just as important.
"We don't consider the discharge process as time-consuming, but it does take almost as much time as an admission does and yet patients are being discharged, even on admitting days,” she says. "The discharge is a very vulnerable time as the literature keeps showing. We need to rethink the discharge process."