An Integrated Nurse Practitioner-Run Subspecialty Referral Program for Incontinent Children.

INTRODUCTION: Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. METHODS: Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. RESULTS: Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. DISCUSSION: This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations.

Methods to confirm feeding tube placement: application of research in practice.

Numerous published studies have demonstrated that conventional methods for documenting proper position of orally or nasally placed feeding tubes in adults are inaccurate. The few available studies done in children indicate similar inadequacies. Auscultation after insufflation of air over the stomach and other less common practices used to verify proper tube position have been shown to be ineffective in predicting correct tube position. Checking pH of aspirate has be recommended as a better method to confirm feeding tube position at the bedside. Careful review of the literature and appropriate application of research findings can lead to change in time-honored nursing practices. Although change is often difficult, a coordinated effort by nurses across organizational lines may facilitate the process.