This article was written by Sue Farkas and Jim Cagliostro.

Cost Savings and Efficiency of Nurses

Nurses increasingly play an integral part in helping health systems to identify cost savings, improve efficiencies, and deliver better patient care.
For years, hospitals have faced the reality of growing financial strain. Increasing debt, decreasing revenues and insufficient reimbursement have all contributed to the unstable financial state of many hospitals.
Since 2018, the average operating margin for US hospitals has hovered around 2%. Furthermore, 30 hospitals entered bankruptcy in 2019, a year which also included the highest number of rural hospital closures on record.
Nursing has been ranked the most trusted profession for 18 years, which ideally places nursing staff as agents of change for hospitals under increasing pressure[1]. A combination of patient-centered training, bedside experience, and in their roles as patient advocates and care coordinators empower nurses to better understand the impact of fiscal decisions on patient care.
Nursing has been the most trusted profession for 18 years, placing nursing staff as agents for change for hospitals under increasing pressure. Click To Tweet
In this article, we examine some key elements of those insights.

Patient Care

Triage Nursing: The nurse’s role in triage is crucial to maximizing efficiency in the Emergency Department.
Triage nurses have the power to appropriately minimize the wait time for more urgent matters, reducing the risk of complications that can lead to poorer outcomes and more expensive care. Appropriate triage also lessens the likelihood of costly malpractice lawsuits.
Triage nurses also have the power to create a positive first impression by reassuring overwhelmed patients and their family members, establishing trust, and setting realistic expectations. All of these factors are essential to creating a positive patient experience and achieving optimal results, leading to higher patient satisfaction scores and reimbursement.
Telehealth: The use of telehealth to connect more patients with frontline workers can also deliver better, more cost-effective care.  Through telehealth, nurses can provide compassionate medical expertise to direct patients to the most appropriate care facility, avoiding unnecessary trips to the ED. They can also provide vital information to patients and liaise with the receiving healthcare facility to prepare for the patient’s arrival in advance.
Nurse Practitioners: Physician shortages in the US are predicted to reach between 34,600-88,000 by 2025[2]. Advanced practice nurses, (particularly Nurse Practitioners), can help to bridge this gap while providing quality care at a more affordable price. Nurse practitioners provide a wide variety of quality health care services, such as:
Physician shortages will reach between 34,600-88,000 by 2025. Nurse practitioners can help to bridge that gap. Click To Tweet

• Diagnosing and treating acute and chronic conditions.
• Prescribing medications.
• Ordering, performing, and/or interpreting diagnostic tests.
• Managing a patient’s care.
• Promoting positive health and lifestyle choices through education and counseling.

These duties are performed with the same, if not better, outcomes at a discounted rate. Typically, their training costs 20-25% less than that of physicians.
Most Nurse Practitioners work as Registered Nurses before beginning their advanced degree, which equips them to meet the needs of patients in various settings. Furthermore, they often have a more direct connection with the patient population and a better understanding of needs and community resources.
These factors lead to high quality care at lower costs.
Care Coordination: Nurses have served as care coordinators and case managers for many years. Lack of coordination contributes to fragmented, inconsistent, and poorly planned care which results in worse patient outcomes. It also leads to repeated and more costly interventions.
As health care transitions to a value-based model, the role of nurses in care coordination has never been more important. As members of the interdisciplinary care team that spend much of their time with patients and their families, nurses best understand patient needs, together with social determinants of health and community resources available to patients upon discharge. The role of the nurse also has a direct impact on patient engagement, long-term health, and the prevention of costly readmissions.
Patient Experience: It can be difficult for hospitals to provide an outstanding patient experience if those patients are in pain or poor health. Nurses who are trained to treat patients holistically are positioned to provide a superior patient experience. Furthermore, they often have the opportunity to create a positive first impression, provide a safe and therapeutic care environment, and leave a healthy last impression for patients and their families. This leads to better outcomes and improved patient satisfaction scores – and ultimately, higher reimbursement.
Nursing and the Expansion of Non-Traditional Roles
According to the American Nurses Association: “21^st Century nursing is the glue that holds a patient’s health care journey together”.
Nursing is described as both an art and a science; nurses are extensively trained in clinical practice and prioritize compassionate patient care. Other qualities of nurses include: critical thinker, team player, quick responder, a calm/composed demeanor, and the ability to listen, comfort, and empathize with patient concerns and afflictions.

Nursing has evolved over the years and encompasses a wide variety of practice areas. Education has transformed the profession, and nurses play a vital role in all sectors of healthcare, including the following roles:
Leadership: Including administrators, managers, providers (Nurse Practitioners, Midwives, and Advanced Practice Nurses), researchers, and educators. They work in direct patient care roles as staff nurses, in specialty areas such as critical care (ICU, NICU, MICU, PACU) ED, OR, special procedures, labor and delivery, behavioral health, infection control, compliance/risk, patient safety, and quality control. They also work in non-traditional roles and in areas such as Informatics, Materials Management, and the Revenue Cycle.
The Institute for Healthcare Improvement’s Triple Aim framework, states that to optimize health care, we must focus on[3]

• Population health.
• Experience of care.
• Cost of providing that care.

Nurses are in a unique position to participate and excel in all three areas.
Financial: Nurses bring clinical knowledge and hands-on patient care experience to the Revenue Cycle. The move to value-based payment models can utilize a nurse’s skill set as a Clinical Documentation Improvement (CDI) Specialist, a Revenue Integrity analyst, and a Nurse Auditor (medical records review, claims denials)[4].
Case management: Nurses perform Utilization Reviews and Case Management. As Case Managers they engage with patients and families as they transition through the continuum of care. They obtain insurance authorization and review patient admissions, LOS, bed availability, and capacity. They build relationships with providers, social workers, payers, and post-acute care facilities in discharge planning.
Nurses also serve on committees and become part of the overall cost-savings team. A Value-Analysis Committee includes representation from leadership, nursing, medical staff, supply chain, and purchasing who evaluate new products for their clinical and financial value to the organization.
Nurse administrators and managers routinely look at budgets, process improvement strategies, and work with their staff to address patient concerns, bottlenecks, and waste.  Daily huddles, open team communication, and managers who welcome suggestions from front-line staff have been proven to identify many hidden cost savings opportunities.
Efficiency: Nurses in specialty areas routinely provide insights into areas to improve efficiency; some examples are the Cleveland Clinic’s “just do it” projects:[5]

• OR/perioperative nursing staff – worked to re-organize supplies, reassessed par levels, optimize replenishment, and decreased waste
• Med/Surg nursing staff- organized and streamlined supplies to save nurses time in searching for needed items

Technology: Nurses have entered the technology domain as Nurse Informaticians. The American Medical Informatics Association(AMIA) describes Nursing Informatics as “the science and practice that integrates nursing, its information and knowledge, with management and communication technologies to promote the health of people, families and communities worldwide.[6]” Nurses who work in this field are analysts, developers, educators, software engineers, CNOs, CIOs, and have been indispensable advisors in telehealth and other software implementations.
System Change for Long-Term Improvement
Minimizing Waste: As frontline, workers, nurses have firsthand experience and knowledge of where the most waste occurs. They are the caregivers who know what patients need and understand the supplies that are most often used and the supplies that most often go unused, whether it is at the bedside or in the operating room. Nurses must be a part of the conversation in this key area.
Evidence-Based Practice: Evidence-Based Practice (EBP) is foundational to nursing and essential for establishing and maintaining quality and safety in the healthcare environment[7]. Nurses rely on EBP to determine what treatments will provide care that is both successful and cost-effective. If clinical trials reveal that a new medication or procedure yields better outcomes with fewer side effects, EBP should guide a change in practice for nurses who care directly for patients. This approach maintains patient safety and leads to better patient outcomes, both of which contribute to cost savings.

Team-Based Care: According to the National Academy of Medicine, team-based care is defined as:[8]
“The provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient – to accomplish shared goals within and across settings to achieve coordinated, high-quality care.”
Patient and family-centered care that utilizes the skills and expertise from multiple healthcare experts leads to more efficient care, better outcomes, enhanced patient experience and improved population health. A healthier population with fewer acute episodes, post-treatment complications and readmissions leads to cost savings.
Care Transition Center: “Care Transition Centers” focus on patient needs surrounding and following discharge from the hospital. This creates efficiency and cost savings for the hospital as it:

• Allows nurses on the floor to focus their time, energy, and expertise to the ongoing needs of their patient group.
• Opens a bed/room sooner, allowing for quicker turnover.
• Creates a more efficient process in which patients can be discharged in a more timely manner.
• Patients can receive the full attention of staff dedicated to the discharge process.

It also improves patient outcomes and the entire patient experience by creating an environment in which:

• Discharge instructions can be clarified.
• Use of medical supplies and equipment can be demonstrated.
• Pharmacists can review medications.
• Patients and family have more opportunity to ask questions.
• Assistance with transportation and community resources that can address specific needs and social determinants of health.

Summary
Nurses provide numerous benefits to healthcare organizations through the variety of roles they fill. In addition, they:

• Understand the value of teamwork in healthcare.
• Work on the frontline of care (they see how changes directly impact patient care/outcomes).
• Understand how healthcare outside the hospital is just as important as inside.
• Understand the needs and risks that patients are faced with upon discharge (optimizing Bundled Payments for Care Improvement (BPCI) and Accountable Care Organizations (ACOs) to arrange not just appropriate care but the best care for each patient beyond the hospital.
• Visit patients in their homes, giving them a better appreciation for the specific needs and challenges of each patient outside the hospital (eg, SDOH).
• Are one of the biggest proponents of preventative health, which minimizes the need for costly care later.
• Understand the importance of evidence-based practice and best practices/staying up-to-date (along with measuring data).
• Have historically exhibited a genuine concern for the health of their patients and the populations they serve.

Whether at the bedside, in non-traditional roles, or through promoting system change, nurses can play a significant role in increasing efficiency, finding cost-savings, and improving hospital operating margins while achieving better patient outcomes.
Identify your hidden cost-saving opportunities & deliver better patient care. Schedule a call with VIE Healthcare today.
[1] https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx
[2] https://www.connectyourcare.com/blog/how-nurse-practitioners-help-reduce-health-care-costs
[3] http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
[4] CDI Management, Sustaining provider engagement remotely at Cooper University Health Care https://acdis.org/resources/sustaining-provider-engagement-remotely-cooper-university-health-care
[5] https://consultqd.clevelandclinic.org/cutting-the-cost-of-supplies/
[6] https://www.amia.org/programs/working-groups/nursing-informatics
[7] https://www.beckershospitalreview.com/quality/evidence-based-practice-the-key-to-advancing-quality-and-safety-in-healthcare.html
[8] https://pcmh.ahrq.gov/page/creating-patient-centered-team-based-primary-care