Background:
The UHS Hospitalist Program of Pitt County Memorial Hospital in Greenville, North Carolina, began in 2001 with 4 physicians and 1 nurse‐practitioner. Since that time, our hospitalist program has grown to 23 physicians and 3.25 nurse‐practitioners. A collaborative comanagement model was implemented in March 2008 and continues to evolve as a successful approach to patient care delivery.
Purpose:
The purpose of the study was to describe an interdisciplinary and collaborative model of care between our physicians and nurse‐practitioners. As a team, these providers have become true partners in care delivery, which has promoted optimal transition of care.
Description:
Since the inception of this service, there has been no formalized structure as to how the physician and nurse‐practitioner provide coordinated care as a team. Historically, physicians and nurse‐practitioners followed patients with minimal collaboration regarding patient care delivery. As this program has grown, this patient care delivery model was recently changed to reflect a truly collaborative approach. In March 2008, we began pairing a physician and nurse‐practitioner as a single care team. With this new model, patients are admitted by 1 of the physicians, and the plan of care is established. When the patient stabilizes and the remaining hospital course can be managed by a nurse‐practitioner, patient care is transitioned over to the nurse‐practitioner. The nurse‐practitioner then manages the patient's care until discharge with ongoing communication with the physician team member. We have found that the nurse‐practitioner often manages cases with complicated dispositions that require time‐intensive case management planning. Nurse‐practitioners are trained to provide this level of care with proficiency. As care is transitioned, the physician and nurse‐practitioner have incorporated bedside rounding as a team with each patient and their family member(s). Satisfaction with this model of care has been positive, and communication has improved between the patients, family members, physicians, and nurse‐practitioners. In addition, a focus on patient‐ and family‐centered care (PFCC) is being actualized, which is a hospital initiative. Average discharge time has been reduced 20‐30 minutes as well since this model was implemented.
Conclusions:
This model of care has proven to be a positive change for our hospitalist service regarding patient care delivery. We have begun building an improved patient care delivery model that balances physician collaboration, nurse‐practitioner autonomy, and patient‐ and family‐centered care. Program development of this model will continue to ensure ongoing enhancement and optimization of communication and transition of care between our physician and nurse‐practitioner providers.
Author Disclosure:
C. Duke, Pitt Co. Memorial Hospital, NA; S. K. Patel, Pitt Professional Services, NA; G. Young, Pitt Co. Memorial Hospital, NA.