Nurse Practitioner Triage of the Neurosurgical Patient: A Patient-Centered Care Delivery Model

Sunday, 29 October 2017: 11:05 AM

Jody L. Miniard, MSN
Kathleen A. Ballman, DNP
College of Nursing, University of Cincinnati, Cincinnati, OH, USA

The Affordable Care Act (ACA) has led to the influx of millions of patients entering the healthcare arena, further complicated by a gap in available providers, leads to a primary concern of timely access to care. Nurse practitioners (NPs) are helping to bridge the gap, not only in primary care but also in specialty practice. The National Sample Survey of Nurse Practitioners (NSSNP) in 2012 reported that approximately one-third of the NP workforce is caring for patients in specialty practices (Coombs, 2015). Of equal consideration Coombs (2015), states that the Association of American Medical Colleges (AAMC) predicts an insufficient supply of specialty physicians by 2025 with the deficit ranging from 28,000 to 63,000. With this deficit in specialty providers and a greater number of nurse practitioners in specialty practice one can see where the bridge is being built, and the gap will fill with NPs providing high quality care to patients.

Nurse practitioners continue to qualify their expertise as valuable, knowledgeable, and reputable healthcare providers (HCPS). In a review of the literature, Stanik-Hutt et al., (2013), concluded that NPs deliver high, quality, care with comparable patient outcomes and patient satisfaction scores when considering care delivered by NPs versus physicians. Furthermore, NPs are essential to timely access of neurosurgical patients seeking care for spinal disorders, and are qualified in diagnosis and treatment plan management of the nonsurgical patient. A review of an NP-led spinal clinic in Canada reports that neurosurgical patients are appropriately referred to the surgeon for surgical decision-making on a timelier basis, when compared to patients awaiting surgeon consultation. Furthermore, NP clinical diagnosis and management plans were equivalent with that of the surgeon 100% and 95% of time respectively (Sarro et al., 2010). Sarro et al. (2010), concludes that NPs appear to be better suited, then surgeons, as non-surgical providers for this population of patients. NPs using their clinical expertise shine when given the opportunity to care for the nonsurgical neurosurgical patients while improving outcomes for patients, families, and community health (Sarro et al., 2010).

In an outpatient, neurosurgical spinal clinic in the Midwest, patient volume exceeded provider availability, and to rectify this problem a proposal for an NP triage system and a NP led spinal clinic was presented. This project’s aim was to contribute to improvement in patient health outcomes, patient satisfaction while delivering high quality, efficient patient centered care to the neurosurgical patient. This project furthers evidence that NPs provide equal if not superior care to patients when compared to surgeons for nonsurgical patients. Changing triage practice methods is the first step in creating NP- led outpatient spinal clinic. Therefore, triage of the neurosurgical patient will lay the foundation for future advance practice nurse advancements in patient care and outcomes, leadership, scholarship, and interprofessional collaboration.

A comparison study was done in which NP patient triaging involved surgeons and NPs simultaneously reviewing patient cases over a 1-month period, with a total number of reviews equaling 100 reviews per NP, for a grand total of 200 test reviews. Two NPs reviewed cases in a test database, while physicians reviewed the same patient cases in the actual database where recommendations will be implemented for the patients. IRB approval was sought and granted.

Data was analyzed for comparison of NP and MD input, in reference to patient diagnosis, patient disposition, diagnostic studies ordered in review, and the appointment type made. Congruency rates were determined, with a goal of at least an 80% congruency between NP and surgeon review. Upon completion of the reviews results indicated that NP and surgeon reviews were congruent 90% or greater in all categories that were analyzed.

Utilization of NPs to facilitate triage and treatment of the outpatient neurosurgical spine patient is a sustainable patient centered care delivery model that leads to improvements in access while reducing cost and ensuring exceptional quality outcomes.