Date of Award

2020-5

Degree Name

PhD Nursing

Dissertation Committee

Cynthia Connelly, PhD, RN, FAAN, Chairperson; Ruth A. Bush, PhD, MPH, FAMIA, Committee Member; Jane M. Georges, PhD, RN, Committee Member

Keywords

Nurse Practitioner, Burns

Abstract

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to care (Newhouse et al., 2011). Few research studies have been conducted in ambulatory settings where residents and APNs are directly compared. Studies which characterize the variability in the care provided in this population can better inform future staffing decisions.

Purpose/Aims: To describe the difference in visit length, pain scores and per patient revenue between patients cared for in an overnight burn clinic by APNs compared to resident physicians. Aim 1: To describe the demographic (age, gender, ethnicity) and clinical variables (time in clinic, pain, provider type) of patients seen in the overnight burn clinic. Aim 2: To examine the relationships among demographics (age, gender, Ethnicity), provider type, pain, and time in clinic in patients cared for in an overnight burn clinic. Aim 3: To identify factors (demographic, pain, and provider data) that explain the variance in the time spent in the clinic. A secondary aim is to examine the difference in revenue generated by APNs.

Setting: A regional burn center walk-in outpatient clinic at a southern California level 1 trauma center.

Design: Retrospective descriptive comparative design.

Cases: All patients who presented to the burn clinic between the hours of 6 pm and 6 am during the time period from October 1, 2015 to November 30, 2019.

Methods: Data were retrieved from the burn registry and the hospital EHR. Descriptive statistics were utilized to address Aim 1. Tests of association were used address Aim 2. Multivariable linear regression was used to address Aim 3. A simple comparison of revenue generated, addressed the secondary aim.

Results: Visit length was shorter for patients seen by nurse practitioners. There was no difference in opiate prescribing during the visit or at discharge. There was a dramatic increase in revenue during the first year.

Conclusions: Burn care is dynamic and evolving. More timely treatment and pain relief in a non-biased environment by specially trained providers has incrementally improved care provided to these vulnerable patients.

Document Type

Dissertation: Open Access

Department

Nursing

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Available for download on Thursday, April 28, 2022

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