Nurse Practitioner Triage of the Neurosurgical Patient: A Patient-Centered Care Delivery Model

Nurse practitioners (NPs) are helping to bridge the gap not only in primary care but also in specialty practice. In an outpatient, neurosurgical spinal clinic in the midwest, patient volume exceeded provider availability, and to rectify this problem, a proposal for an NP triage system and an NP-led spinal clinic was presented.

The aim of this project was to use NPs to facilitate patient triage in an outpatient neurosurgical practice to expedite patients' access to care and ultimately improve patient satisfaction, outcomes, and healthcare expenditure.

A prospective comparison study was conducted in which NP patient triaging involved surgeons and NPs simultaneously reviewing patient cases over a 1-month period, with a total number of reviews equaling 100 reviews per NP, for a grand total of 200 test reviews. Data were analyzed for a comparison of NP and surgeon input, in reference to patient diagnosis and appropriate NP referral for surgical consultation. Institutional review board approval was sought and granted.

Nurse practitioner and surgeon diagnoses were congruent 100% of the time. Patients triaged were correctly referred to the clinic for surgical consultation, with a sensitivity of 95.7% (95% confidence interval, 90.8%-98.4%) and a specificity of 73.8% (95% confidence interval, 60.9%-84.2%).

Utilization of NPs to facilitate triage and treatment of the outpatient neurosurgical spine patient is a sustainable patient-centered care delivery model that leads to improvements in access and ensures exceptional quality outcomes.