Service-Based Advanced Practice Providers: The Surgeon's Perspective

2019 ◽  
Vol 85 (7) ◽  
pp. 747-751 ◽  
Author(s):  
Barbara Eaton ◽  
Lindsay O'Meara ◽  
Anthony V. Herrera ◽  
Ronald Tesoriero ◽  
Jose Diaz ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Best Practice ◽  
Positive Impact ◽  
Advanced Practice ◽  
Near Misses ◽  
Tertiary Referral Center ◽  
Practice Level ◽  
Resident Work ◽  
Surgical Teams ◽  
Surgery Resident

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.

Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey

2020 ◽  
pp. 000313482095692
Author(s):  
Barbara C. Eaton ◽  
Roumen Vesselinov ◽  
Mentor Ahmeti ◽  
Jessica Jean Stansbury ◽  
Justin Regner ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Judgment ◽  
Best Practice ◽  
Resident Education ◽  
Positive Impact ◽  
Advanced Practice ◽  
Safe Patient Care ◽  
Surgical Subspecialty ◽  
Multicenter Survey ◽  
Potential Improvement

Background A previous single-center survey of trauma and general surgery faculty demonstrated perceived positive impact of trauma and surgical subspecialty service-based advanced practice providers (SB APPs). The aim of this multicenter survey was to further validate these findings. Methods Faculty surgeons on teams that employ SB APPs at 8 academic centers completed an electronic survey querying perception about advanced practice provider (APP) competency and impact. Results Respondents agreed that SB APPs decrease workload (88%), length of stay (72%), contribute to continuity (92%), facilitate care coordination (87%), enhance patient satisfaction (88%), and contribute to best practice/safe patient care (83%). Fewer agreed that APPs contribute to resident education (50%) and quality improvement (QI)/research (36%). Although 93% acknowledged variability in the APP level of function, 91% reported trusting their clinical judgment. Conclusion This study supports the perception that SB APPs have a positive impact on patient care and quality indicators. Areas for potential improvement include APP contribution to resident education and research/QI initiatives.

scholarly journals Performance of Village Unit Co-Operatives in Yogyakarta Special Region: A Data Envelopment Analysis Approach

2017 ◽  
Vol 1 (2) ◽  
pp. 067
Author(s):  
Abi Pratiwa Siregar ◽  
Jamhari Jamhari ◽  
Lestari Rahayu Waluyati
Keyword(s):  
Data Envelopment Analysis ◽  
Technical Efficiency ◽  
Best Practice ◽  
Negative Impact ◽  
Positive Impact ◽  
Three Dimensions ◽  
Scale Efficiency ◽  
Data Envelopment ◽  
Rice Milling ◽  
Special Region

This study assessed the performance of 32 village unit co-operatives (KUD) in Yogyakarta Special Region during 2011 to 2012. The efficiency level of the KUD were evaluated by employing the data envelopment analysis and multiple regression analysis using panel data to determine the factors affecting efficiency level. Efficiency analysis was decomposed into three dimensions to explore possible sources of inefficiency. According to Marwa and Aziakpono (2016), the first dimension was technical efficiency, which explored the overall effectiveness of transforming the productive inputs into desired outputs compared to the data-driven frontier of best practice. The second dimension was pure technical efficiency, which captured managerial efficiency in the intermediation process. The third dimension was scale efficiency, which explored whether KUD were operating in an optimal scale of operation or not. The results found that the average scores are 64%, 92%, and 68% for technical, pure technical, and scale efficiency respectively in 2011, while in 2012 the average scores are 57%, 94%, and 60% for technical, pure technical, and scale efficiency. Factors having significantly positive impact on several measures of efficiency are incentive and dummy variables (agriculture inputs and hand tractor). Accounts receivable only has positive relationship to pure technical efficiency. On the other hand, rice milling unit and electricity services have negative impact with several measures of efficiency.

Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

2006 ◽  
Vol 15 (2) ◽  
pp. 130-148 ◽  
Author(s):  
Deborah Becker ◽  
Roberta Kaplow ◽  
Patricia M. Muenzen ◽  
Carol Hartigan
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Clinical Judgment ◽  
American Association ◽  
Critical Care Nurses ◽  
Advanced Practice ◽  
Clinical Nurse ◽  
Care Nurse ◽  
Clinical Nurse Specialists

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

scholarly journals The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey

2019 ◽  
Vol 19 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Elisabetta Salutini ◽  
Enrico Brocco ◽  
Roberto Da Ros ◽  
Luca Monge ◽  
Luigi Uccioli ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Diabetic Foot ◽  
Best Practice ◽  
Diabetes Complications ◽  
Public Health Issue ◽  
Life Threatening ◽  
Foot Lesions ◽  
Diabetic Foot Lesions ◽  
Wound Bed Preparation ◽  
Leg Amputation

Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.

scholarly journals Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study

JRSM Open ◽  
2020 ◽  
Vol 11 (10) ◽  
pp. 205427042096957
Author(s):  
Vari M Drennan ◽  
Melania Calestani ◽  
Francesca Taylor ◽  
Mary Halter ◽  
Ros Levenson
Keyword(s):  
Positive Impact ◽  
Physician Assistants ◽  
Junior Doctors ◽  
Medical Council ◽  
Positive Contribution ◽  
Clinical Placements ◽  
Acute Hospitals ◽  
Experienced Physician ◽  
Surgical Teams ◽  
American Physician

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

scholarly journals Are Global Companies Better in Environmental Efficiency in India? Based on Metafrontier Malmquist CO2 Performance

2020 ◽  
Vol 12 (20) ◽  
pp. 8359
Author(s):  
Yongrok Choi ◽  
Hyoungsuk Lee ◽  
Jahira Debbarma
Keyword(s):  
Host Country ◽  
Best Practice ◽  
Positive Impact ◽  
Green Technology ◽  
Environmental Efficiency ◽  
Innovation Performance ◽  
Domestic Firms ◽  
Technological Gap ◽  
Global Companies ◽  
Catch Up

There is a rapid increase in inflows of foreign direct investment (FDI) into developing countries such as India. Some researchers argue that FDI has a positive impact on sustainable development in terms of environmental efficiency and brings innovative green technology to the host country. In contrast, others claim that FDI brings considerable pollution to the host country, and their motive is only to yield profit. To address this issue, this paper analyzes environmental efficiency between FDI and domestic firms in India for seven years between 2012 and 2018. The research aims to evaluate the performance of FDI firms in terms of environmental efficiency in India after implementing certain policy regulations, nationally and globally. In this analysis, we use the non-radial metafrontier Malmquist CO2 performance index (NMMCPI) with three decomposition indices: efficiency change index, best practice gap index, and technological gap change index. Our empirical results indicate that domestic firms have performed well in terms of better catch-up and innovation performance. On the other hand, FDI firms only demonstrated higher technology leadership performance, indicating weaker catch-up performance and weaker innovation performance. From the results, we proposed that policymakers should harmonize between the FDI promotion and regulation in its sustainable performance because global companies are not sensitive to the local regulations, and not very proactive in implementing the global standard of eco-friendliness.

149. Surgery Resident Work-Hour Restrictions: Impact on Patient Care, Surgical Education and Resident Quality of Life

2009 ◽  
Vol 151 (2) ◽  
pp. 241-242
Author(s):  
S.D. Holubar ◽  
V.L. Tsikitis ◽  
K. Malireddy ◽  
R.R. Cima ◽  
D.W. Larson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Care ◽  
Surgical Education ◽  
Resident Work ◽  
Work Hour ◽  
Surgery Resident

Development of provincial clinical standards for the province of Ontario.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 117-117
Author(s):  
Sara Urowitz ◽  
Denise Marshall ◽  
Jeff Myers ◽  
Deanna Bryant
Keyword(s):  
Palliative Care ◽  
Stakeholder Engagement ◽  
Best Practice ◽  
Positive Impact ◽  
Quality Care ◽  
Clinical Environment ◽  
Consensus Process ◽  
High Quality ◽  
Clinical Change ◽  
Clinical Standards

117 Background: The province of Ontario is committed to improving palliative care services. This commitment to change is outlined in The Declaration of Partnership, the provincial roadmap for improving palliative care. To help drive this change in the clinical environment, a Clinical Council for Palliative Care was established to be responsible for providing direction on clinical implications of policy, and advancing clinical improvement in palliative care in Ontario. To this end, Clinical Council has articulated a set of 12 interrelated provincial clinical standards which outline priority areas for clinical change and improvement in the province. Methods: Key stakeholder engagement was undertaken to identify evidence-based, best practices for delivery of palliative services. A consensus process was used to identify the priority set of essential clinical standards for high quality care that is both practical and scalable. Expert working groups were established to refine the standards based on evidence and leading or best practice to the Ontario context. Response was solicited from stakeholders, and qualitative analysis was conducted; standards will be refined based on feedback. Results: Based on the results of the stakeholder engagement, a “Clinical Change Strategy” was identified and a set 12 “clinical imperatives” were identified. Through the consensus process 12 Provincial Clinical Standards were endorsed. Conclusions: Engaging in an evidence informed process with key stakeholders has enabled the creation of a set of 12 interconnected Provincial Clinical Standards for palliative care in Ontario. These standards will help to advance high quality palliative care in the province. The standards represent a population health based strategy for change, which can have a positive impact at the systems level. Stakeholder feedback will result in further refinement of the standards, which will ultimately provide the foundation for standardized approaches for palliative services across Ontario.

Education and Training in Pediatric Cardiac Critical Care

2017 ◽  
Vol 8 (6) ◽  
pp. 707-714 ◽  
Author(s):  
Mary E. McBride ◽  
Dorothy M. Beke ◽  
James D. Fortenberry ◽  
Annette Imprescia ◽  
Louise Callow ◽  
...  
Keyword(s):  
Critical Care ◽  
Positive Impact ◽  
Fellowship Training ◽  
Advanced Practice ◽  
Critical Care Nursing ◽  
Certification Process ◽  
Nursing Experience ◽  
Standardized Curriculum ◽  
Cardiac Critical Care ◽  
And Training

Pediatric cardiac critical care is a new and emerging field. There is no standardization to the current education provided, and high-quality patient outcomes require such standardization. For physicians, this includes fellowship training, specific competencies, and a certification process. For advanced practice providers, a standardized curriculum as well as a certification process is needed. There is evidence that supports a finding that critical care nursing experience may have a positive impact on outcomes from pediatric cardiac surgery. A rigorous orientation and meaningful continuing education may augment that. For all disciplines and levels of expertise, simulation is a useful modality in the education in pediatric cardiac critical care.

Standards to Guide the Use of Clinical Judgment in the Field of Intellectual Disability

2015 ◽  
Vol 53 (3) ◽  
pp. 240-251 ◽  
Author(s):  
Ruth Luckasson ◽  
Robert L. Schalock
Keyword(s):  
Intellectual Disability ◽  
Current Literature ◽  
Clinical Judgment ◽  
Best Practice ◽  
Diagnosis Classification

Abstract The purpose of this article is to discuss 10 Clinical Judgment Standards and associated best practice indicators based on current literature and an understanding of the context of clinical judgment. Throughout the article, we stress the important role that clinical judgment plays in formulating valid and precise decisions and recommendations regarding diagnosis, classification, and planning supports.

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