A Collaborative Staffing Model: Utilizing Nurse Practitioners and Physicians on the Hospitalist Service

The purpose of this needs assessment is to determine an effective solution to provide additional coverage to the hospitalist service. It also serves to identify what patient factors are responsible for increases in workload for the hospitalist service. Studies indicate that an increase in patient age, acuity, comorbidity and requests for co-management lead to increased lengths of stay and workload for providers, which leads to poorer patient outcomes (Elliot, Young, Brice, Aguiar, Kolm 2014). An evaluation of the current staffing model to determine resources was conducted and used as a baseline template for staffing needs. General admission tends to the service were tracked for the previous 3 years and found an increase in patient admission volumes by 5.85%. A retrospective chart review of 7096 patients was performed on all admissions to the service for the previous year to determine how age, acuity, co-morbidity and length of stay (LOS) affect workload. It was found that a patient age of 61-65 significantly affects both length of stay and patient acuity, which could explain increases in workload due to the average admission age of 62. Co-management requests were also identified to determine their impact on workload and were found to increase daily patient census by 12 patients. Utilizing the data from chart review and comparing it to the current staffing model allowed us to project future staffing needs and create a staffing model. It was found that the service could benefit from hiring 6 additional full-time equivalent providers. Evaluation of current salaries for both physicians and advance practice clinicians (APCs) found a significant cost savings (25%) for a staffing model that incorporates APCs. Studies have also shown that use of APCs have comparable outcomes as resident teams making them an affordable option that will still meet the needs of the patient (Wall, Scudamore, Chin, Rannie, Tong, Reese, & Wilson 2014).