Abstracts

Rationale: As part of health care reform, nurse practitioners are believed to be cost effective health care providers but a paucity of literature supports this assumption. As costs escalate, all health care providers, including NPs are asked to work more efficiently. In Canada, many hospitals capture NP workload efficiency through direct face to face clinical contact but mechanisms for tracking telephone care are lacking. When this type of care is not quantified it becomes invisible and its impact unknown. This ' silent care' then becomes an under recognized form of health care from several perspectives including how it affords timely access to care, affects health care utilization by keeping patients out of emergency rooms, and impacts on health care provider workload. Methods: Method: Program Evaluation The NP in Paediatric Neurology at the Children s Hospital, London Health Sciences Centre treats a variety of neurology patients. The program evaluation method was implemented to obtain a timely and constructive systematic assessment of patient calls specific to the NP s epilepsy practice, which comprises forty percent of her clinical portfolio. As there was no formal organizational tracking mechanism for telephone care, a data base was created to assess the reason for the call, time spent on care, and specifically to determine what the caller would have done if the NP had not available to treat the child. In 2012, over a seven month period each patient call that required NP intervention was tracked (Table 1). Overestimating was used when calculating the NP cost by assigning the maximum hourly NP wage and including benefits cost. Underestimating was used when calculating the health utilization cost. For example, if family stated more than one option (i.e. family doctor or emergency room) the lesser cost was assigned. This cost was calculated using the current Ontario Schedule of Benefits for Physician Services fees and provincial hospital emergency room utilization costs. Additionally, costs to family such as lost working hours, transportation costs, child care, and other costs such as ambulance costs were not included in the overall health care utilization costs.Results: Results. A total health care cost savings of $19, 015. 13 was realized for this seven month period with the NP providing on average four hours of epilepsy telephone care per week or the equivalent of an additional half clinic day per week. Conclusions: This program evaluation demonstrates the cost savings of epilepsy telephone care by providing timely access to care and keeping children out of emergency rooms and physician offices, and keeping families in their communities. It also demonstrated additional NP workload not previously accounted for. The challenge remains that as many nurses and physicians perform this type of 'silent' patient care there is a need to formally track it to demonstrate the impact on professional workload and health care savings, especially in a health care setting where budgets are siiloed.