Studying and Supporting Collaborative Care Processes

In patient care today, teams of practitioners from various disciplines must coordinate their efforts in order to deliver care successfully. Frontline nurses and physicians must interact with social workers, therapists, physician assistants, nurse practitioners, and others to develop and carry out coordinated plans of care. Also, clinical team members must communicate with patients and their families in language that can be understood and acted upon. In support of these goals, JCAHO standards require patient care to be planned and provided in an interdisciplinary, collaborative manner. As hospital units develop processes for collaborative care in complex environments such as post-surgery and critical care units, it is important to understand what constitutes success for these processes and how they can be enabled and supported. This report documents a series of field visits and simulations designed to observe, videotape, and interview collaborative care team members, patients, and family members engaged in varying forms of collaborative practice. This ongoing research is being conducted by a multi-disciplinary team of medical and social scientists with a shared goal of studying and supporting collaborative care processes.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch004 ◽

2015 ◽

pp. 86-104

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽

10.4018/978-1-5225-0549-5.ch027 ◽

2017 ◽

pp. 709-727

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

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An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

Human Resources for Health ◽

10.1186/s12960-019-0423-z ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

G. T. W. J. van den Brink ◽

A. J. Kouwen ◽

R. S. Hooker ◽

H. Vermeulen ◽

M. G. H. Laurant

Keyword(s):

The Netherlands ◽

Patient Care ◽

Nurse Practitioners ◽

Hospital Management ◽

Physician Assistants ◽

Added Value ◽

Direct Patient Care ◽

Patient Scheduling ◽

Dutch Hospital ◽

Medical Specialties

Abstract Background The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management. Study design A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated. Methods The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system. Findings In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care. Conclusions NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

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Board-Certified Oncology Pharmacists: Their Potential Contribution to Reducing a Shortfall in Oncology Patient Visits

Journal of Oncology Practice ◽

10.1200/jop.2015.008490 ◽

2016 ◽

Vol 12 (4) ◽

pp. e359-e368 ◽

Cited By ~ 18

Author(s):

Robert Ignoffo ◽

Katherine Knapp ◽

Mitchell Barnett ◽

Sally Yowell Barbour ◽

Steve D’Amato ◽

...

Keyword(s):

Health Care ◽

Cancer Treatment ◽

Patient Care ◽

Nurse Practitioners ◽

Physician Assistants ◽

Delphi Panel ◽

Potential Contribution ◽

Oncology Patient ◽

Care Services ◽

Number Of Patients

Purpose: With an aging US population, the number of patients who need cancer treatment will increase significantly by 2020. On the basis of a predicted shortage of oncology physicians, nonphysician health care practitioners will need to fill the shortfall in oncology patient visits, and nurse practitioners and physician assistants have already been identified for this purpose. This study proposes that appropriately trained oncology pharmacists can also contribute. The purpose of this study is to estimate the supply of Board of Pharmacy Specialties–certified oncology pharmacists (BCOPs) and their potential contribution to the care of patients with cancer through 2020. Methods: Data regarding accredited oncology pharmacy residencies, new BCOPs, and total BCOPs were used to estimate oncology residencies, new BCOPs, and total BCOPs through 2020. A Delphi panel process was used to estimate patient visits, identify patient care services that BCOPs could provide, and study limitations. Results: By 2020, there will be an estimated 3,639 BCOPs, and approximately 62% of BCOPs will have completed accredited oncology pharmacy residencies. Delphi panelists came to consensus (at least 80% agreement) on eight patient care services that BCOPs could provide. Although the estimates given by our model indicate that BCOPs could provide 5 to 7 million 30-minute patient visits annually, sensitivity analysis, based on factors that could reduce potential visit availability resulted in 2.5 to 3.5 million visits by 2020 with the addition of BCOPs to the health care team. Conclusion: BCOPs can contribute to a projected shortfall in needed patient visits for cancer treatment. BCOPs, along with nurse practitioners and physician assistants could substantially reduce, but likely not eliminate, the shortfall of providers needed for oncology patient visits.

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Understanding the Role of Advanced Practice Providers in Oncology in the United States

Journal of Oncology Practice ◽

10.1200/jop.18.00181 ◽

2018 ◽

Vol 14 (9) ◽

pp. e518-e532 ◽

Cited By ~ 16

Author(s):

Suanna S. Bruinooge ◽

Todd A. Pickard ◽

Wendy Vogel ◽

Amy Hanley ◽

Caroline Schenkel ◽

...

Keyword(s):

Patient Care ◽

Nurse Practitioners ◽

Clinical Care ◽

Gynecologic Oncology ◽

Physician Assistants ◽

The United States ◽

Direct Patient Care ◽

Advanced Practice ◽

Patient Counseling ◽

Number Of Patients

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

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Role of Oncology Clinical Pharmacists in Light of the Oncology Workforce Study

Journal of Oncology Practice ◽

10.1200/jop.000037 ◽

2010 ◽

Vol 6 (5) ◽

pp. 270-272 ◽

Cited By ~ 36

Author(s):

Jolynn K. Sessions ◽

John Valgus ◽

Sally Yowell Barbour ◽

Lew Iacovelli

Keyword(s):

Patient Education ◽

Patient Care ◽

Nurse Practitioners ◽

Physician Assistants ◽

Direct Patient Care ◽

Clinical Pharmacists

To date, the information published regarding workforce implications has focused on physicians, nurse practitioners, and physician assistants. But oncology clinical pharmacists also can assist with direct patient care and patient education activities.

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Role of advanced practice providers (APP) in meeting rising demands on oncology practices.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18372 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18372-e18372

Author(s):

Bela Bapat ◽

Yolaine Smith ◽

Andrew Klink ◽

Chadi Nabhan ◽

Bruce A. Feinberg

Keyword(s):

Patient Care ◽

Nurse Practitioners ◽

Physician Assistants ◽

Patient Treatment ◽

Advanced Practice ◽

Physician Burnout ◽

Community Oncology ◽

Practice Efficiency ◽

Physician Availability

e18372 Background: The role of advanced practice providers (APPs), nurse practitioners (NPs) and physician assistants (PAs), is expanding in oncology for myriad reasons including improving access to care by closing the gap between demand for services and physician availability. This is especially true in oncology, where the shortage of oncologists and increasingly cited physician burnout is creating challenges for many practices and communities. Methods: We surveyed US physicians to understand their practices’ use of APPs, their role in patient treatment and support as well as their impact on practice workflow. Data were collected using web-based instrument between Sep 2018 and Nov 2018. Responses have been summarized using descriptive statistics. Results: Among 163 oncologists and hematologists surveyed, 74.2% (n = 121) employed NPs, 39.9% (n = 65) employed PAs, and 19.0% (n = 31) did not employ any APPs in their practice. Amongst practices that employed ≥1 APP (n = 132; 81.0%), over 40% of physicians reported a 1:3 APP: physician ratio. Most (62.1%) physicians stated that APPs only evaluated and saw returning patients, whereas 35.6% physicians used APPs to evaluate and see both new and return patients. More than 60% of physicians stated that APPs enhanced their practice efficiency, enabled physicians to focus more on complex patient cases, and made their workload manageable. By employing APPs, 52.3% of physicians were able to increase their patient caseload. The majority (57.6%) of physicians reported that they would employ more APPs in the next 3 years if resources were available, and 41.7% of physicians reported that APPs would likely take on additional responsibility in the next 3 years. Conclusions: Most community oncology practices in the US are employing APPs and are finding significant value in the APP roles by delegating various aspects of patient care to them. Most community practices are considering increasing the number of employed APPs and to expand the breadth of their responsibility. Integrating APPs into oncology practices is likely to have a larger impact on quality of patient care and potential mitigation of physician burnout.

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Patient-Centered Medical Home With Colocation: Observations and Insights From an Academic Family Medicine Clinic

Journal of Primary Care & Community Health ◽

10.1177/2150132720902560 ◽

2020 ◽

Vol 11 ◽

pp. 215013272090256

Author(s):

George G. A. Pujalte ◽

Sally Ann Pantin ◽

Thomas A. Waller ◽

Livia Y. Maruoka Nishi ◽

Floyd B. Willis ◽

...

Keyword(s):

Family Medicine ◽

Nurse Practitioners ◽

Physician Assistants ◽

The United States ◽

Care Team ◽

Patient Centered ◽

Team Members ◽

Auditory Distance ◽

Practice Style ◽

Almost All

There is a movement in the United States to transform family medicine practices from single physician–based patient care to team-based care. These teams are usually composed of multiple disciplines, including social workers, pharmacists, registered nurses, physician assistants, nurse practitioners, and physicians. The teams support patients and their families, provide holistic care to patients of all ages, and allow their members to work to the highest level of their training in an integrated fashion. Grouping care team members together within visual and auditory distance of each other is likely to enhance communication and teamwork, resulting in more efficient care for patients. This grouping is termed colocation. The authors describe how the use of colocation can lead to clearer, faster communication between care team members. This practice style has the potential to be expanded into various clinical settings in any given health system and to almost all clinical specialties and practices.

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Abstract 187: Ethics of Codes: Provider Perspectives on Cardiopulmonary Resuscitation Duration

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.187 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Tiffany J Young ◽

Sarah Perman ◽

Margaret Daeschler ◽

Daniel Kolansky ◽

David Gaieski ◽

...

Keyword(s):

Emergency Medicine ◽

Nurse Practitioners ◽

Rapid Response Team ◽

Physician Assistants ◽

Average Score ◽

Future Research ◽

Provider Attitudes ◽

Team Members ◽

Provider Perspectives ◽

End Tidal

Background: Code success can be influenced by many factors such as location of arrest, length of code, patient comorbidities, but also bias. Current recommendations for code duration range from ten to thirty minutes. Recent data suggests that longer resuscitation efforts may result in favorable outcomes. We sought to examine provider attitudes toward code duration and appropriateness. Methods: Email invitations were sent to residents in internal medicine and emergency medicine, nurses, midlevel providers, rapid response team members, and attending physicians in emergency medicine and cardiology at a single academic institution. The survey evaluated experience with codes as well as knowledge of recommendations and literature concerning code duration and outcomes. Email invitations were sent to 605 providers in 2 waves; 162 (26.8%) completed the survey. Results: Of respondents, 82 (51%) were female. A majority (n=59, 36%) were age 26-30 and were Caucasian (n=117, 75%). The sample included 47 (29%) attendings, 44 (28%) residents, 37 (23%) nurses, 19 (12%) fellows, 11 (7%) interns, and 2 (1%) physician assistants/nurse practitioners. Only 34% of respondents indicated they were familiar or very familiar with literature on code duration and outcomes (range: 56% of attendings, 21% of residents). A substantial minority, 32%, believed a “slow code” to be appropriate or very appropriate, when the team believes resuscitation is futile and the patient/family disagrees, including 35% of nurses and 50% of interns, 28% of women and 34% of men. On the 5 point scale, respondents rated the importance of each of the following factors in deciding when to stop CPR: code duration (average score=4.11), patient comorbidities (3.95), patient’s age (3.68), initial rhythm (3.55), end tidal CO2 measurement (2.94), and location of arrest (2.75). Every respondent over age 50 (100%) agreed or strongly agreed that comorbid conditions were important when deciding to end a code vs. 70% under age 50 (p=0.003). Conclusions: This preliminary study suggests that a variety of factors may influence decisions about code termination which may not be in line with emerging evidence. A substantial minority of respondents considered slow codes to be appropriate in the setting of futility. Future research is needed to determine the knowledge base and decision-making processes of providers who participate in decisions about CPR duration.

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