Researchers at Loyola University Health System have shown that adding a nurse practitioner (NP) to an in-patient hospital surgical department can decrease post-operative emergency department (ED) visits. According to a study just published in Surgery, by improving the continuity in care and troubleshooting problems for patients, an NP can reduce ED visits. The addition of an NP also resulted in an improved use of resources and financial benefits for the health system.
NP’s are advanced practice registered nurses who have completed graduate-level education (either a Master’s or a Doctoral degree) and have a dramatically expanded scope of practice over the traditional RN role. Their core philosophy is individualized care. Nurse practitioners focus on patients’ conditions as well as the effects of illness on the lives of patients and their families and make prevention, wellness, and patient education their priorities.
The study analyzed 415 patient records one year before and one year after the NP joined the staff. The two groups were statistically similar in age, race, type of surgery, length of hospital stay and hospital readmissions. Patients were tracked after they were sent home from the hospital to determine how many unnecessarily returned to the ED (defined as an ED visit that did not result in an inpatient admission).
Mary Kay Larson, the nurse practitioner involved with this study, communicated with patients and coordinated their discharge plan. During this time, telephone conversations with patients increased by 64%; and visiting nurse, physical therapy or occupational therapy services increased from 25% before Larson joined the department to 39% after. Most importantly, these services resulted in 50% fewer unnecessary ED visits.
“This study demonstrates the important role that nurse practitioners have in our increasingly complex health-care system,” said senior author Margo Shoup, MD, FACS, Division Director of Surgical Oncology, Loyola University Health System. “Hospitals must continue to adapt to the changing health-care environment. The addition of a nurse practitioner clearly represents a way that we can adjust to meet the increasing demands of patient care while we are being asked to do more with less.”
SRxA has long recognized the value of NP’s and physician assistants (PA’s) in both patient and peer-to-peer education. To help our clients gain access to this important and rapidly growing group of health professionals we have recently established an NP/PA group. For more information, and to find out how you can leverage their expertise in your next project, contact us today.
If you watched the news at all over the past week you probably saw CNN‘s Sanjay Gupta‘s confrontation with disgraced doctor Andrew Wakefield. He, as you may recall was the author of the 1998 study that linked autism to some childhood vaccines and set off a worldwide scare for parents.
In the intervening years there have been countless lawsuits against vaccine manufacturers and millions of children who, perhaps needlessly, have gone unvaccinated. Recently, an investigative report published in the British Medical Journal called the original study an elaborate fraud.
So, is Dr Wakefield alone in manipulating clinical trial data? Can we rely on other clinical studies to provide us with the truth?
No, not according to researchers at Johns Hopkins. In a report published January 4th in the Annals of Internal Medicine the authors concluded that the vast majority of published clinical trials of a given drug, device or procedure are routinely ignored by scientists conducting new research on the same topic.
Trials being done may not be justified, because researchers are not looking at or at least not reporting what is already known. In some cases, patients who volunteer for clinical trials may be getting a placebo for a medication that a previous researcher has already determined works or may be getting a treatment that another researcher has shown is of no value. In rare instances, patients have suffered severe side effects and even died in studies because researchers were not aware of previous studies documenting a treatment’s dangers.
Not surprising then that they go on to say, “the failure to consider existing evidence is both unscientific and unethical.”
The report argues that these omissions potentially skew scientific results, waste taxpayer money on redundant studies and involve patients in unnecessary research.
Conducting an analysis of published studies, the Johns Hopkins team concludes that researchers, on average, cited less than 21% of previously published, relevant studies in their papers. For papers with at least five prior publications available for citation, one-quarter cited only one previous trial, while another quarter cited no other previous trials on the topic. Those statistics stayed roughly the same even as the number of papers available for citation increased. Larger studies were no more likely to be cited than smaller ones.
“The extent of the discrepancy between the existing evidence and what was cited is pretty large and pretty striking,” said Karen Robinson, Ph.D., co-director of the Evidence Based Practice Center (EPIC) at the Johns Hopkins University School of Medicine and co-author of the research. “It’s like listening to one witness as opposed to the other 12 witnesses in a criminal trial and making a decision without all the evidence. Clinical trials should not be started — and cannot be interpreted — without a full accounting of the existing evidence.”
The Hopkins researchers could not say why prior trials failed to be cited, but Robinson says one reason for the omissions could be the self-interest of researchers trying to get ahead.