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Development of a program to manage costly outliers.

The advanced practice nurse group devised a method to identify clinical variables of the elderly patients with multisystem failure requiring complex nursing care referred to as outlier. Outliers in this program were defined as patients whose hospital charges were greater than $50,000 with a length of stay greater than the primary diagnostic related group designated. Once criteria were identified, nursing strategies were developed to monitor the elderly patient, implement interventions, and evaluate patient outcomes. The goals of this program were to identify who the outliers might be prior to becoming outliers and to manage their nursing care early in their hospital course, attempting to match resource requirements with resource availability.