Impact of an inpatient advanced practice provider on hospital length of stay after major urologic oncology procedures.

INTRODUCTION: Although timely hospital discharge is a complex and multifactorial process, this metric is consistently a focus for hospitals and health care systems. It also has been a long practice that the American Urological Association (AUA) supports the use of advanced practice providers (APPs) as an integral member of the urological care team. MATERIALS AND METHODS: Here, we performed a preliminary evaluation of the effectiveness of an inpatient APP in reducing hospital length of stay (LOS) following major urologic oncology procedures. Surgical outcomes, surgeon data, and LOS for open and minimally invasive urologic oncology procedures, including radical prostatectomy, partial or radical nephrectomy, and radical cystectomy, were compiled over a 4-year period (pre-APP: 2014-2016 and post-APP: 2018-2020). Univariate descriptive statistics analyzed the association of an inpatient APP in with reducing hospital LOS over time. RESULTS: Average LOS decreased in all surgical procedures and for all surgeons in the post-APP setting, irrespective of surgical approach (P< 0.05). CONCLUSIONS: An inpatient APP was associated with a decrease of hospital LOS for urologic oncology patients over time. Such observations underscore the likely economic benefit to the health care system and potential improved coordination of care and satisfaction for patients undergoing major urologic oncology procedures.

Obstetric risk score - revalidated for triaging high-risk pregnancies in rural areas.

BACKGROUND: A pregnancy risk score system in popular use in provincial and rural Queensland to assist with the triage decisions regarding the appropriate facility for pregnancy care has been upgraded with more recently recognised pregnancy risk factors. AIMS: To review the usefulness of the revised pregnancy risk score system and the integrity of its continuing use. MATERIALS AND METHODS: 459 women attending regional/rural hospitals and 1963 women attending a major specialist hospital for their pregnancy care had a prospective risk score assessed, and the resulting score was examined in relationship to pregnancy outcomes. RESULTS: There was a statistically significant positive relationship between a risk score of eight or more and an adverse outcome and a statistically significant negative relationship between a risk score of zero or one and adverse outcomes. CONCLUSION: This study revalidates the risk score process for use in provincial and rural Queensland in delineating those women requiring care in a location with higher levels of clinical service capability. Women with a risk score of 8 or more have an increased likelihood of needing birth intervention and/or having an adverse neonatal outcome and should be recognised as needing the development of a multidisciplinary care plan and assessment in a facility that is appropriately resourced for their end of pregnancy care.