Direct Cost Savings Analysis of Nurse Practitioner for Inpatient Urology Practice

Introduction: A 2015 survey of members of the American Urological Association found the majority of urologists (62.7%) work with an advanced practice provider. The aim of this study was to analyze direct cost savings of inpatient advanced practice provider hiring focusing on direct cost, length of stay, readmission rate and discharge planning. Methods: Data from a single tertiary care referral center was collected between 2015 Q (quarter) 1 to 2018 Q2. Seven quarters before inpatient advanced practice provider implementation (2015 Q1 to 2016 Q3) were compared to 7 subsequent quarters after initiation of inpatient nurse practitioner program (2016 Q4 to 2018 Q2). A total of 1,190 major urological cases were performed during this time (178 cystectomies, 663 nephrectomies, 349 prostatectomies). Factors influenced by inpatient advanced practice provider such as length of stay, discharge before 11 a.m. and total direct cost were analyzed before advanced practice provider and after advanced practice provider. Mann-Whitney U and chi-square tests were used for continuous and categorical data, respectively. Results: Advanced practice provider inclusion as part of a urology health care team showed an overall decreased length of stay (p=0.042) with an increase in discharges before 11 a.m. (p <0.001). There was no significant change in direct cost (p=0.89) combined for all 3 groups, but direct cost in the cystectomy group was significantly lower (p=0.048). There was a statistically significant improvement in discharge time for nephrectomy (p=0.039) and cystectomy (p=0.02) after advanced practice provider program initiation. Conclusions: Inclusion of an advanced practice provider within inpatient setting was shown to consistently improve length of stay and direct cost for cystectomy care.