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The added value of the advanced practice provider in paediatric acute care cardiology

Published online by Cambridge University Press:  04 November 2020

Amanda J. Willis Open the ORCID record for Amanda J. Willis [Opens in a new window] ,
Amanda Hoerst ,
Stephen A. Hart ,
Diana Holbein ,
Kristyn Lowery ,
Ashraf S. Harahsheh Open the ORCID record for Ashraf S. Harahsheh [Opens in a new window] ,
Alaina K. Kipps ,
Nicolas Madsen ,
Sonali S. Patel  and
Ronn E. Tanel Open the ORCID record for Ronn E. Tanel [Opens in a new window]
Amanda J. Willis*
Affiliation:
Texas Children’s Hospital, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
Amanda Hoerst
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Stephen A. Hart
Affiliation:
Nationwide Children’s Hospital, Department of Paediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
Diana Holbein
Affiliation:
Department of Paediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Kristyn Lowery
Affiliation:
Department of Paediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
Ashraf S. Harahsheh
Affiliation:
Children’s National Hospital, Department of Paediatrics, The George Washington University School of Medicine, Washington, DC, USA
Alaina K. Kipps
Affiliation:
Lucile Packard Children’s Hospital, Department of Paediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Nicolas Madsen
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Sonali S. Patel
Affiliation:
Children’s Hospital of Colorado, Department of Paediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Ronn E. Tanel
Affiliation:
UCSF Benioff Children’s Hospital, Department of Paediatrics, UCSF School of Medicine, San Francisco, CA, USA
*
Author for correspondence: A. J. Willis, DNP, Texas Children’s Hospital, Department of Paediatrics, 6651 Main Street, Suite E.1920, Houston, TX 77030, USA. Tel: +832-826-5949; Fax: +832-825-9637. E-mail: [email protected]
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Abstract

Objectives:

Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS).

Study design:

The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson’s correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS.

Results:

Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0–5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001).

Conclusions:

The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.

Keywords

Nurse practitionerphysician assistantcare modelfront-line providercollaborative
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 248 - 251
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Hoerst, A, Bakar, A, Cassidy, SC, et al. Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC(3)) hospital survey. Congenit Heart Dis 2019; 14: 419–426.CrossRefGoogle ScholarPubMed
Mott, AR, Neish, SR, Challman, M, Feltes, TF. Defining pediatric inpatient cardiology care delivery models: A survey of pediatric cardiology programs in the USA and Canada. Congenit Heart Dis 2017; 12: 294–300.CrossRefGoogle ScholarPubMed
O’Brien, P. The role of the nurse practitioner in congenital heart surgery. Pediatr Cardiol 2007; 28: 88–95.CrossRefGoogle ScholarPubMed
Freed, GL, Dunham, KM, Moran, LM, Spera, L, Research Advisory Committee of the American Board of P. Resident work hour changes in children’s hospitals: impact on staffing patterns and workforce needs. Pediatrics 2012; 130: 700–704.CrossRefGoogle ScholarPubMed
Rodgers, GP, Conti, JB, Feinstein, JA, et al. ACC 2009 survey results and recommendations: Addressing the cardiology workforce crisis A report of the ACC board of trustees workforce task force. J Am Coll Cardiol 2009; 54: 1195–1208.CrossRefGoogle ScholarPubMed
Lambrew, CT, Dove, JT, Friday, BA, et al. Working group 5: Innovative care team models and processes that might enhance efficiency and productivity. J Am Coll Cardiol 2004; 44: 251–255.CrossRefGoogle Scholar
Woo, BFY, Lee, JXY, Tam, WWS. The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Hum Resour Health 2017; 15: 63.CrossRefGoogle Scholar
Schulman, M, Lucchese, KR, Sullivan, AC. Transition from housestaff to nonphysicians as neonatal intensive care providers: cost, impact on revenue, and quality of care. Am J Perinatol 1995; 12: 442–446.CrossRefGoogle ScholarPubMed
Newhouse, RP, Stanik-Hutt, J, White, KM, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ 2011; 29: 230–250; quiz 251.Google ScholarPubMed
Knaus, VL, Felten, S, Burton, S, Fobes, P, Davis, K. The use of nurse practitioners in the acute care setting. J Nurs Adm 1997; 27: 20–27.CrossRefGoogle ScholarPubMed
Kipps, AK, Cassidy, SC, Strohacker, CM, et al. Collective quality improvement in the paediatric cardiology acute care unit: establishment of the Pediatric Acute Care Cardiology Collaborative (PAC3). Cardiol Young 2018; 28: 1019–1023.CrossRefGoogle Scholar
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.CrossRefGoogle ScholarPubMed
Gaies, M, Cooper, DS, Tabbutt, S, et al. Collaborative quality improvement in the cardiac intensive care unit: Development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 2015; 25: 951–957.CrossRefGoogle Scholar
Franklin, RCG, Beland, MJ, Colan, SD, et al. Nomenclature for congenital and paediatric cardiac disease: the International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD-11). Cardiol Young 2017; 27: 1872–1938.CrossRefGoogle Scholar
Gaies, M, Donohue, JE, Willis, GM, et al. Data integrity of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Cardiol Young 2016; 26: 1090–1096.CrossRefGoogle ScholarPubMed
Hart, SA, Tanel, RE, Kipps, AK, et al. Intensive care unit and acute care unit length of stay following congenital heart surgery. Ann Thorac Surg 2020; 110: 1396–1403.CrossRefGoogle Scholar
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