Nursing care delivery models may sound intimidating, but it simply refers to “how” nurses deliver care. A care delivery model combines the site of care, team skills and mode of care, such as primary versus team-based care. Over the last few years, more healthcare organizations have begun prioritizing professionals with a Doctor of Nursing Practice (DNP) for their skill sets and experience in redesigning care delivery.
Three trending nursing care modules that fit into either traditional fee-for-service payment models or alternative payment models (APMs) include team-based acute care, hybrid team-based care and acute care at home.
- Team-Based Nursing Care Models
Team-based acute care nursing was once the traditional care delivery model before the shift to primary care nursing model. Since the COVID-19 pandemic, organizations have re-evaluated patient care models for a more patient-centered, integrated team staffing approach. Instead of having the highest level of education, the team leader has the highest skill level.
Navigation is a care delivery model that merges primary care into team-based care delivery principles. Nurse navigators are the primary point of contact as they educate and facilitate care. They serve as the bridge between the patient and care team members to remove barriers to care, assist in care coordination and ensure admissions for only acutely ill patients.
- Remote and Virtual Care Hybrid Models
Since the telehealth explosion during COVID-19, a hybrid team-based care approach is emerging with remote patient monitoring and virtual teams plus “boots-on-the-ground” team members. Within this care delivery model, command centers offer hybrid remote patient monitoring with an equal operations view of patient movement. In the past, command centers only existed during grand-scale emergencies such as natural disasters. However, during the pandemic, organizations formed COVID-19 command centers to focus on hospital-level bed availability, staffing, flow and efficiency.
Today, more organizations have permanent operational and clinical command centers. The traditional house supervisor office expands to include environmental services, food services and key representatives from various areas such as the perioperative area, cardiac catheterization lab and women’s services.
In addition, clinical command centers can use real-time clinical data (or just-in-time information) in combination with artificial intelligence (AI). With predictive analytics, teams can identify high-risk patients for certain complications and extract meaningful data for effective decision-making. For example, HCA Healthcare uses a Sepsis Prediction and Optimization (S-P-O-T) AI to continuously monitor patients for early signs of sepsis and alert clinicians for early intervention, decreasing sepsis mortality by 23%.
- Acute Care at Home
Due to staffing and hospital bed shortages, acute care continues to shift to the home with a Hospital at Home type model. Patients who would typically receive care at an emergency or ambulatory site receive acute-level home care, including diagnostic studies, treatment and skilled nursing services. In addition, telehealth and remote monitoring provide a care delivery system that aligns with improving care access, communication and timeliness of care. Patients prefer care at home, hospitals need bed availability for critically ill patients and payors want the best return on investments.
Critical Role of DNP in Care Delivery
Nursing care delivery models must be responsive to demographic, organizational or the communal healthcare environment. DNPs can help transform healthcare in the following ways:
- DNPs often lead healthcare facilities and organizations when making decisions that impact patient care. They help address the need for increased knowledge and skills for clinical and administrative leadership across healthcare delivery services and sites. A DNP program prepares graduates to improve these systems via transformational, evidence-based leadership by appraising and expediting care evidence into implementation.
- Evidence-based practice. Since it takes roughly a decade and a half for clinical evidence to diffuse into practice, DNP-prepared nurses expedite information from “bench to bedside.” When there is no supporting evidence, a DNP-prepared leader works collaboratively with Ph.D. nurse colleagues to inquire and find the evidence to support or refute the care practice. With a symbiotic relationship, they co-create effective patient care programs that achieve the quintuple aim of guiding the future of healthcare.
- Future of healthcare. Graduates of a DNP program are uniquely qualified to achieve healthcare aims. First known as the triple aim for healthcare improvement, then the quadruple aim, there is now a five-part aim of health, experience, cost, staff well-being and equity. This final aim focuses on identifying disparities; designing and implementing evidence-based interventions to reduce them; and investing and incentivizing the achievement of equity. In addition, DNP-prepared nurses can ensure that patient outcomes are STEEP (safe, effective, patient-centered, timely, efficient and equitable) thus aligning with the Agency for Healthcare Research and Quality.
Northern Kentucky University’s online Post-Master’s Doctor of Nursing Practice program helps students conceptualize new care delivery models based on contemporary nursing science. These models are feasible within current organizational, political, cultural and economic perspectives. The program prepares graduates to conceptualize new care delivery models to create effective workflow solutions to lower healthcare costs and improve patient care.