Background:
The addition of a clinical nurse specialist (CNS) to an inpatient medical team has been shown to reduce length of stay (LOS) and improve patient satisfaction. Many hospitalists practice in nonteaching settings and without the assistance of other dedicated team members. The purpose of this study was to evaluate the effect of a hospitalist‐CNS team on patient outcomes and physician satisfaction in a nonteaching hospitalist service setting.
Methods:
This study was conducted over a 12‐week period. Each week 2‐4 of the 5 hospitalists on the nonteaching service were randomly assigned to work either with or without a CNS. Unit‐based social workers and discharge planners were available for all hospitalists during the study. Patients were admitted to hospitalist services according to a rotating cycle. Patient demographic data and LOS were obtained from hospital databases. At the end of each week, the hospitalists were given a survey to evaluate how they perceived the efficiency of their work and their satisfaction during the past week. A survey designed for patients to evaluate satisfaction with the discharge process was administered by telephone 7‐14 days postdischarge during the last 6 weeks of the study. Patient demographic and patient survey data were compared using chi‐square and Student t tests. We conducted multivariate linear regressions using log‐transformed length of stay as the dependent variable and adjusted for clustering of physicians. A priori, we eliminated patients with an LOS ≤ 1 day from the analysis, as the addition of a CNS is unlikely to shorten the LOS of these patients. Hospitalist survey data were compared by linear regression and adjusted for clustering of physicians.
Results:
We compared 279 patients cared for by hospitalist‐CNS teams to 262 patients cared for by hospitalists alone. Patients in the 2 groups were similar in age, sex, race, and payer type. Mean LOS was 0.43 days shorter for patients cared for by hospitalist‐CNS teams than for those cared for by hospitalists alone (P = .015). This result remained statistically significant (P = .046) after adjusting for covariates. Sixty end‐of‐week surveys were completed by hospitalists (response rate 100%). Of the 31 responses about working with a CNS, 28 (90%) indicated that working with a CNS improved efficiency and job satisfaction. Hospitalists rated their efficiency higher when working with a CNS (mean for items scaled 4.10 vs. 3.05, P < .001). Of 217 eligible patients, 71 (32.7%) completed the discharge satisfaction survey. Although not statistically significant, there was a trend toward improved overall satisfaction (8.72 vs. 8.26, P = .45) among patients discharged with the assistance of a CNS.
Conclusions:
The hospitalist‐CNS team reduced LOS and improved hospitalist satisfaction on a nonteaching hospitalist service. Patient satisfaction with the discharge process was not improved; however, the low patient response rate may have affected this finding.
Author Disclosure:
K. J. O'Leary, None; L. A. Lindquist, None; J. A. Thompson, None; D. W. Baker, None.