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Sunday, November 1, 2009
Learning Objective 1: describe the origins and development of evidence based health care.
Learning Objective 2: describe and discuss the steps of the systematic review process.
There are 1.5 million people living in nursing homes in the United States (Pear, 2008). Nursing home patients are sicker than they have been in the past 10 years, and the frail, sick patients are more likely to be hospitalized (Ouslaner, Weinberg, & Phillips, 2000). Transferring patients to the hospital for assessment is a common practice in nursing homes. However, it proves to be costly for both the patient and for society (Xiao, Barber, & Campbell, 2004).
Unnecessary hospitalization of nursing home patients is a costly and critical problem in our healthcare system (Ouslaner et al., 2000). For the patient, hospital transfers from a nursing home is a risk to their already fail health. Hospitalization can cause irreversible decline in function for the elderly patient and can “expose residents to iatrogenic disease and delirium” (Intrator & Mor, 2004, 393). For society, hospital care is the most expensive component of theUnited States ’ health care expenditures (Xiao, Barber, & Campbell, 2004). Nurse practitioners can play a valuable role in caring for the long term care patient, reducing unnecessary hospital admissions, and supporting the physician’s practice. A NP on site in the nursing home can provide quick assessment and treatment when a patient has a change of condition. The NP can intervene and treat the patient as needed, instead of transferring the patient to the hospital. The objective of this systematic review is to evaluate the effectiveness of having a NP in the nursing home in decreasing the rate of patient hospitalizations. Hospitalization of a nursing home patient has a cascade of negative events for the patient. Decreasing hospitalizations of nursing home patients can improve quality of life for the patient and possibly prevent further decline or injury.
Unnecessary hospitalization of nursing home patients is a costly and critical problem in our healthcare system (Ouslaner et al., 2000). For the patient, hospital transfers from a nursing home is a risk to their already fail health. Hospitalization can cause irreversible decline in function for the elderly patient and can “expose residents to iatrogenic disease and delirium” (Intrator & Mor, 2004, 393). For society, hospital care is the most expensive component of the