eP158 - Addition of an Advanced Practice Provider Reduces Length of Stay for Inpatient Colorectal Surgery Service

ePoster Presenter(s)

• 

  Shannon Easton, MSN, AGACNP-BC, RN (she/her/hers)

  Inpatient Nurse Practitioner
  Penn Medicine
  University of Pennsylvania
  Havertown, PA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• EN

  Erin Nardella, PA-C

  Manager of Surgical APPs
  Pennsylvania Hospital
  Ambler, Pennsylvania, United States

  Disclosure information not submitted.
• MD

  Melissa C. Dunlop, PA-C, MBA, FACHE, DFAAPA

  Director, Advanced Practice Providers
  Penn Medicine Pennsylvania Hospital
  Oreland, Pennsylvania, United States

  Disclosure information not submitted.
• MC

  Maya N. Clark-Cutaia, PhD, ACNP-BC, RN

  Nurse Practitioner & Nurse Scientist
  Pennsylvania Hospital, Penn Medicine
  Philadelphia, Pennsylvania, United States

  Disclosure information not submitted.
• KL

  Karen A. Lodge, ACNP

  Nurse Practitioner
  Penn Medicine
  Erdenheim, Pennsylvania, United States

  Disclosure information not submitted.
• GY

  Gary Yu, PhD

  Statistician
  Columbia University
  New York, New York, United States

  Disclosure information not submitted.
• 

  Joshua I. S Bleier, MD (he/him/his)

  Chair of Surgery, Pennsylvania Hospital; Program Director Colorectal Fellowship
  University of Pennsylvania
  University of Pennsylvania
  Bala Cynwyd, PA, United States

  Disclosure information not submitted.
• 

  Nicole M. Saur, MD, FACS, FASCRS (she/her/hers)

  Associate Professor of Clinical Surgery
  University of Pennsylvania
  University of Pennsylvania
  Philadelphia, PA, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no relevant relationships with ineligible companies.

Purpose/Background: Integration of Advanced practice providers (APPs) into surgical service lines have been associated with increased adherence to evidence-based practice, decreased resource utilization, improved patient care outcomes (e.g.; length of stay (LOS), reduced thirty-day readmissions) and increase nurse satisfaction and positive patient experience (Htay & Whitehead, 202;1 Kapu et al., 2016; Hiza et al., 2015; Parker & Hill, 2017; McDonnell et al., 2015). Building upon these facts, the purpose of this quality improvement project was to integrate an APP into the colorectal surgery service line at an academic, tertiary care center, and determine the impact on length of stay, nursing satisfaction, discharge times, and patient readmission rates.Methods/Interventions: We employed a quasi-experimental design. Data were retrospectively collected. We abstracted data from 2021 to 2023, before and after the incorporation of the APP in June of 2021. Four outcome indicators were measured: LOS and thirty-day readmissions. Using variability at the surgeon level, we used two sample tests of proportions to test for the differences in the percentage of 30-day readmissions, and two sample tests of independent samples to test for differences in the mean of LOSResults/Outcomes: There were 334 discharges in FY 2021, and 325 and 342 in FY 2022 and 2023 respectively. Average discharge times were 1430 in FY 2021, 1515 in FY 2022, and 1416 in FY 2023. LOS decreased from 5.95 days in FY21, to 5.12 days in FY22, and 4.77 days in FY23. Percent readmission rates were 13.2% in FY 2021 and 13.5% in FY 2023. There were no statistically significant differences in LOS or readmission rates.Conclusion/

Discussion: The addition of a dedicated APP to a service line that had been exclusively covered by surgical residents has been shown to improve outcomes. While there were no statistically significant differences in LOS and readmission rates in this quality improvement project, the differences are potentially clinically meaningful. Additionally, given the trend, over time, with increasing volume these differences will likely be statistically significant. Future investigation into APP outcomes should include prospective data collection, with a larger sample size and focus on nursing and patient centered outcomes, such as satisfaction."Length of Stay of Colorectal Patients

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