Quantifying The Benefit Of Nurse Practitioners In Pediatric Trauma
Ainsley E Timmel1, *Jonathan E Kohler2, Benjamin Eithun2, Susan Jones2, Randi Cartmill2, Jessica Draper2
1University of Wisconsin SMPH, Madison, WI;2University of Wisconsin, Madison, WI
Pediatric trauma patients require multidisciplinary teams and significant coordination of care. Nurse practitioners (NPs) are increasingly used in inpatient care, but their role in pediatric trauma has not been well-defined. Early evaluation by child life, physical, occupational, and speech/swallow therapy have been shown to improve outcomes. We measured the effect of a dedicated trauma NP at a Level I Pediatric Trauma Center on length of stay (LOS) and consultation of ancillary services.
A retrospective cohort study of trauma patients admitted to a Level I Pediatric Trauma Center, comparing 2015 (pre-NP) to 2017 (post-NP, hired in mid-2016). Outcomes included LOS and consults completed. Patients were stratified by diagnosis and demographic factors. Groups were compared using Mann-Whitney t-tests.
In 2015, 526 patients averaged a LOS of 2.74 days. In 2017, 514 patients averaged a LOS of 2.45 days (p=NS). The percentage of patients with consults increased significantly:
|Percentage of Admitted Trauma Patients with Consults from Select Ancillary Services||2015||2017||p-value|
|Child Life Services||42.02%||90.86%||<0.001|
|Pediatric Rehabilitation Medicine||45.25%||59.14%||<0.001|
|Speech/Swallow Therapy||32.13 %||54.87%||<0.001|
The addition of an NP to the pediatric trauma department increased ancillary service consults completed during admission without increasing LOS. Patients were 2.2x more likely to see child life services, 1.4x more likely to see occupational therapy, 1.3x more likely to see rehabilitation medicine, 1.2x more likely to see physical therapy, and 1.7x more likely to see speech/swallow therapists. Other pediatric trauma centers may benefit from using a similar model.
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