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Henry SM, Westerband D, Adelstein M. Trauma training transformed: empowering nurse practitioners and physician assistants in advanced trauma life support teaching. Trauma Surg Acute Care Open 2024; 9:e001345. [PMID: 38450046 PMCID: PMC10916088 DOI: 10.1136/tsaco-2023-001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Affiliation(s)
- Sharon M Henry
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dany Westerband
- Acute Care Surgery, Suburban Hospital Inc, Bethesda, Maryland, USA
| | - Michelle Adelstein
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
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Trauma Bay Time Clocks: Influence on Emergency Department Length of Stay. J Trauma Nurs 2021; 28:269-274. [PMID: 34210948 DOI: 10.1097/jtn.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To monitor the time elapsed since patient arrival in the emergency department, Trauma Services at the study institution installed a large digital stopwatch timer placed at the head of each trauma bay on June 5, 2017. This quality improvement endeavor became an essential component of performance evaluation. OBJECTIVE The purpose of the study is to measure the impact of trauma bay time clocks on emergency department length of stay. METHODS This is a retrospective before-and-after study of trauma activation patients between June 2015 and May 2019. Two 24-month intervals were compared before and after installation of time clocks. RESULTS In full activation patients, outcomes of emergency department length of stay ≤50 min (39.2% vs. 61.7%, p < .001) and time to transfer to intensive care unit ≤56 min (45.3% vs. 55.1%, p = .002) were significantly favorable in the postimplementation phase. Time to first computed tomography scan and time to first operating room from arrival to the emergency department were comparable between both phases. For limited activation patients, positive changes were noted in emergency department length of stay ≤87 min (41.4% vs. 60.6%, p < .001), time to first computed tomography scan ≤32 min (47.7% vs. 53.0%, p = .015), and time to transfer to intensive care unit ≤74 min (50.2% vs. 57.2%, p = .008). Time to first operating room remained comparable between two periods. CONCLUSIONS The study institution improved their provision of immediate care by using time clocks in trauma bays. This is a simple and cost-effective intervention and may benefit similar institutions.
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Eaton BC, Vesselinov R, Ahmeti M, Stansbury JJ, Regner J, Sadler C, Nevarez S, Lissauer M, Stout L, Harmon L, Glassett B, Hampton DA, Castro HJ, Cunningham K, Mulkey S, O'Meara L, Dia JJ, Bruns BR. Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey. Am Surg 2020; 87:971-978. [PMID: 33295188 DOI: 10.1177/0003134820956929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Barbara C Eaton
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, Department of Anesthesiology, 12264University of Maryland, Baltimore, MD, USA
| | - Mentor Ahmeti
- 23506Sanford Medical Center Fargo, ND, USA.,School of Medicine and Health Sciences, 12281University of North Dakota, ND, USA
| | | | | | - Craig Sadler
- 6040Eastern Virginia Medical School, VA, USA.,Norfolk General Hospital, VA, USA
| | | | | | | | | | | | - David A Hampton
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Helen J Castro
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | | | | | - Lindsay O'Meara
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Jose J Dia
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Brandon R Bruns
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
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Mitchell BP, Stumpff K, Berry S, Howard J, Bennett A, Winfield RD. The Impact of the Tertiary Survey in an Established Trauma Program. Am Surg 2020; 87:437-442. [PMID: 33026239 DOI: 10.1177/0003134820951449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The trauma tertiary survey (TTS) was first described in 1990 and is recognized as an essential practice in trauma care. The TTS remains effective in detecting secondary injuries in the modern era. METHODS Trauma patients discharged between August 1, 2016, and December 31, 2016, were identified in our trauma registry. Collected data include TTS completion rates, detection of injuries, type of provider, and timing. TTS documentation was qualitatively evaluated. RESULTS Out of 407 patients, 264 patients (65%) received a TTS. Injury detection rate was 1.1.%. Average time to TTS was 41 hours. TTS were completed by resident physicians (46%) and advanced practice providers (APPs; 46%). TTS documentation was more complete for APPs than for resident physicians. CONCLUSION TTS remains an integral component of modern trauma care. Ongoing education on the significance of TTS and the importance of thorough documentation is essential. Provision of real-time feedback to providers is also critical for improving current practices.
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Affiliation(s)
- Brendan P Mitchell
- 12251 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly Stumpff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stepheny Berry
- 12251 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - James Howard
- 12251 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ashley Bennett
- 12251 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert D Winfield
- 12251 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Impact of a Dedicated Advanced Practice Provider Model for Pediatric Trauma and Burn Patients. J Trauma Nurs 2020; 27:297-301. [PMID: 32890246 DOI: 10.1097/jtn.0000000000000532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A free-standing, academic Level 1 pediatric trauma and verified pediatric burn center created a dedicated trauma and burn service advanced practice provider role, and restructured rounds. The changes were implemented to improve patient care. METHODS A pre and postintervention study using historical controls was performed to compare 18 months prior (preintervention) and 18 months following (postintervention) practice changes. Data collection included demographics, injury characteristics, length of stay (LOS), complications, and patient satisfaction results. RESULTS When compared with the preintervention period, the postintervention period had a higher patient volume and an increased number of severely injured patients. Mean LOS was stable for all patients and trauma patients, as were the complication rates related to trauma and burns. However, the mean LOS/total body surface area (TBSA) burned decreased from 1.36 to 1.04 days/TBSA (p = .160) in burn patients and from 0.84 to 0.62 days/TBSA (p = .060) in those with more than 5% TBSA. Patient satisfaction scores were stable in the categories of nursing care and the child's physician. Despite an increase in the volume and severity of patients, there was a clinically meaningful decrease in burn patient LOS/TBSA. CONCLUSION The addition of a dedicated advanced practice provider and restructured trauma service appears to provide a benefit to pediatric burn patients.
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Eaton B, O'Meara L, Herrera AV, Tesoriero R, Diaz J, Bruns B. Service-Based Advanced Practice Providers: The Surgeon's Perspective. Am Surg 2020. [DOI: 10.1177/000313481908500736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Barbara Eaton
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Lindsay O'Meara
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Anthony V. Herrera
- Center for Shock, Trauma and Anesthesiology Research, Baltimore, Maryland; and
| | - Ronald Tesoriero
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jose Diaz
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brandon Bruns
- Division of Acute Care Surgery, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Structure and function of a trauma intensive care unit: A report from the Trauma Intensive Care Unit Prevalence Project. J Trauma Acute Care Surg 2020; 86:783-790. [PMID: 30741885 DOI: 10.1097/ta.0000000000002223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specialized trauma intensive care unit (TICU) care impacts patient outcomes. Few studies describe where and how TICU care is delivered. We performed an assessment of TICU structure and function at a sample of US trauma center TICUs. METHODS This was a multicenter study in which participants supplied information about their trauma centers, staff, clinical protocols, processes of care, and study TICU (the ICU admitting the majority of trauma patients). RESULTS Forty-five Level I trauma centers trauma centers enrolled through the American Association for the Surgery of Trauma multi-institutional trials platform; 71.1% had less than 750 beds and 55.5% treated 1,000 to 2,999 trauma activations/year. The median number of hospital ICU beds was 109 [66-185]. 46.7% were "closed" ICUs, 20% were "open," and 82.2% had mandatory intensivist consultation. 42.2% ICUs were classified as trauma (≥80% of patients were trauma), 46.7% surgical/trauma, and 11.1% medical-surgical. Trauma ICUs had a median 10 [7-12] intensivists. Intensivists were present 24 hours/day in 80% of TICUs. Centers reported a median of 8 (interquartile range [IQR], 6-10) full-time trauma surgeons, whose ICU duties comprised 25% (IQR, 20%-40%) of their clinical time and 20% (IQR, 20-33) of total work time. A median 16 (IQR, 12-23) ICU beds in use were staffed by 10 (IQR, 7-14) nurses. There was considerable variation in the number and type of protocols used and in diagnostic methods for ventilator-associated pneumonia. Daily patient care checklists were used by 80% of ICUs. While inclusion of families on rounds was performed in 91.1% of ICUs, patient- and family-centered support programs were less common. CONCLUSION A study of structure and function of TICUs at a sample of Level I trauma centers revealed that presence of nontrauma patients was common, critical care is a significant component of trauma surgeons' professional practice, and significant variation exists in care delivery models and protocol use. Opportunities may exist to improve care through sharing of best practices. LEVEL OF EVIDENCE Therapeutic/Care management, level IV.
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Analysis of an American College of Surgeons Committee on Trauma (ACS-COT) Approved Pilot Project: Increasing Provider Communication During Interhospital Transfer. J Trauma Nurs 2020; 27:6-12. [PMID: 31895313 DOI: 10.1097/jtn.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The American College of Surgeons Committee on Trauma requires physician-to-physician communication prior to interhospital transfer. This requirement can be difficult to achieve in high-volume trauma centers. This pilot project utilizes trauma advanced practice providers (APPs) as the primary communicator, in lieu of the trauma surgeon, prior to interhospital transfer. The hypothesis suggests that APPs can provide safe recommendations and accurately triage patients for the highest level trauma alert. From January to April 2018, a total of 1,145 patients were transferred to a Level I or Level II trauma center. All interhospital trauma transfers were dispatched through a designated transfer center APP (TCAPP). Descriptive statistics were used to describe the frequency of core TCAPP recommendations, including reversal agents for anticoagulants, antibiotics for open fractures, direct admission criteria, administration of blood products, and triaging to the highest level of trauma activation. TCAPP triage accuracy was analyzed and reported as percentages. Percentages are compared between independent groups using a chi-square test. Prior to implementation of the TCAPP role, provider-to-provider communication occurred in less than 1% of interhospital transfers; TCAPP-to-provider communication occurred 92% of the time (p < .001). During the study period, the TCAPP made 398 care-related recommendations. Three (<1%) TCAPP recommendations were deemed inappropriate. The TCAPP (89.7%) and physician (89.9%) triage accuracy was not significantly different (p = .43). Interhospital transfer communication and recommendations can be performed safely and accurately by a trauma trained APP.
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Pastores SM, Kvetan V, Coopersmith CM, Farmer JC, Sessler C, Christman JW, D'Agostino R, Diaz-Gomez J, Gregg SR, Khan RA, Kapu AN, Masur H, Mehta G, Moore J, Oropello JM, Price K. Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review. Crit Care Med 2019; 47:550-557. [PMID: 30688716 DOI: 10.1097/ccm.0000000000003637] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN Data were synthesized from monthly expert consensus and literature review. SETTING Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
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Affiliation(s)
- Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Craig M Coopersmith
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | | | - Curtis Sessler
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - John W Christman
- Division of Pulmonary, Allergy, Critical Care and Sleep, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rhonda D'Agostino
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Sara R Gregg
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | - Roozehra A Khan
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - April N Kapu
- Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Henry Masur
- Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Gargi Mehta
- Jay B. Langner Critical Care System, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | - Jason Moore
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John M Oropello
- Division of Critical Care Medicine, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - Kristen Price
- Department of Critical Care Medicine, MD Anderson Cancer Center, Houston, TX
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Eaton B, Hessler L, O'Meara L, Herrera A, Tesoriero R, Diaz J, Bruns B. The impact of advanced practice providers on the surgical resident experience: Agree to disagree? Am J Surg 2018; 217:1107-1111. [PMID: 30343880 DOI: 10.1016/j.amjsurg.2018.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. Statistical analysis compared responses using a Pearson chi-square test. RESULTS Thirty-two resident/fellows (48%) and 10 APPs (42%) responded. There was consensus that having an APP on service decreases workload, contributes to continuity of care and enhances resident-patient coordination education and agreement that there was clear communication and adequate collaboration. Both groups differed with respect to APPs contribution to resident/fellow clinical education, role definition and chain of command. The majority of trainees felt that APPs function at a PGY2 level (51.7%) compared to APPs, who felt that they functioned at a PGY4/5 (22%) or Fellow (44%) level. CONCLUSION APPs and resident/fellows agree that APPs impact resident workload, continuity of care and patient-coordination education.
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Affiliation(s)
- B Eaton
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA.
| | - L Hessler
- Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - L O'Meara
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA.
| | - A Herrera
- Center for Shock, Trauma and Anesthesiology Research, 110 South Paca St, Room 03-002, Baltimore MD, 21201, USA.
| | - R Tesoriero
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - J Diaz
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
| | - B Bruns
- University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore MD 21201, USA.
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Blitzer D, Stephens EH, Tchantchaleishvili V, Lou X, Chen P, Pattakos G, Vardas PN. Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey. Ann Thorac Surg 2018; 107:597-602. [PMID: 30312614 DOI: 10.1016/j.athoracsur.2018.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/12/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in healthcare have led to increasing use of advanced practice providers (APPs), but their role in cardiothoracic surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP use on the CTS team, their role within the hierarchy of clinical care, and the impact of physician extenders on CTS training from the resident perspective. METHODS CTS residents' responses to the 2017 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association In-Service Training Examination survey regarding the role of APPs in specific clinical scenarios and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS (version 22.0; IBM, Chicago, IL) using a Fisher's exact test and Pearson χ2 test with statistical significance set at p < 0.05. RESULTS Response rate was 82.1% (280/341). The median number of employed APPs was 16 to 20, and 50.4% (n = 141) reported 11 to 25 physician extenders at their institution. The median numbers of APPs in the operating room, floor, and intensive care unit were three, three, and two, respectively. Overall impression of APPs was positive in 87.5% (n = 245) of respondents, with 47.7% (n = 133) "very positive" and 40.1% "positive" (n = 112). In general, residents reported greater resident involvement in postoperative issues and operative consults and greater APP involvement in floor issues; 72.5% of residents had not missed a surgical opportunity due to APPs, whereas 9.6% missed an opportunity due to APPs despite being at an appropriate level of training. Of those that reported missed opportunities 44% were integrated thoracic surgery residents. There were no significant differences in APPs' operative role based on resident seniority. CONCLUSIONS The overall impression of APPs among CTS residents was favorable, and they are more commonly involved in assisting on the floor or the operating room. Occasionally residents reported missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role within programs to improve clinical outcomes and enhance the CTS educational experience for residents.
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Affiliation(s)
- David Blitzer
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth H Stephens
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | | | - Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Peter Chen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Greg Pattakos
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, Texas
| | - Panos N Vardas
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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Daniel VT, Ayturk D, Kiefe CI, Santry HP. The current State of the acute care surgery workforce: A boots on the ground perspective. Am J Surg 2018; 216:1076-1081. [PMID: 30224074 DOI: 10.1016/j.amjsurg.2018.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. METHODS The American Hospital Association (AHA) Annual Survey of Hospitals database was queried to identify acute care general hospitals. A hybrid mail/electronic survey was sent to 2811 acute care hospitals that met the inclusion criteria of hospitals that care for adult patients (≥18 years old) with an emergency room (ER), ≥ 1 operating room (OR), and 24-h ER access. Hospitals were queried on whether they utilized an ACS model. The workforce composition among ACS and non-ACS hospitals was evaluated using X2 tests, t tests, and Wilcoxon rank-sum tests. RESULTS Survey response was 60% (N = 1690). ACS hospitals had a higher proportion of emergency surgeons who were female (20% vs. 14%, p < 0.0001), newly-trained (17% vs 10%, p < 0.0001), critical care trained (78% vs. 31%, p < 0.0001), and who had an additional degree (35% vs. 13%, p < 0.0001). More ACS hospitals had 24/7 in-house OR nursing staff (72% vs. 15%, p < 0.0001) and ancillary staff. CONCLUSIONS ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
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Affiliation(s)
- Vijaya T Daniel
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Didem Ayturk
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Heena P Santry
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Torbeck LJ, Hockaday M, Smith C, Dunnington G. Optimizing the integration of advanced practitioners in a department of surgery: An operational improvement model. Am J Surg 2018; 217:597-604. [PMID: 30055805 DOI: 10.1016/j.amjsurg.2018.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Physician assistants (PAs) and nurse practitioners (NPs) have established themselves as key members of the healthcare team to supplement practicing physicians in patient care. PAs and NPs are collectively referred to as "advanced providers" (APs) and work not only in primary care but in general surgery and surgical subspecialties. Studies have addressed AP integration into the profession of medicine and have examined cost and efficacy of APs, attitudes about APs among residents, and educational impact of APs, but very little literature exists that describes a formalized approach to AP integration into a department of surgery, specifically with AP/resident integration. The purpose of this paper is to describe an initiative for developing an operational improvement model for APs working with residents on surgical inpatient services in a large academic health center. The model consists of four components and each component is described in detail from discovery state towards continuous improvement. Formal professional development opportunities for APs as well as appointing a Clinical Director for Surgical APs have positively impacted AP integration into the department of surgery.
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Affiliation(s)
- Laura J Torbeck
- Indiana University, Department of Surgery, 545 Barnhill Dr., Emerson Hall 543, Indianapolis, IN, 46202, United States.
| | - Melissa Hockaday
- Indiana University Health, Methodist Hospital B230, 1701 North Capitol Avenue, Indianapolis, IN, 46202, United States
| | - Cecelia Smith
- Indiana University Health Physicians, 950N. Meridian St., Suite 500, Indianapolis, IN, 46204, United States
| | - Gary Dunnington
- Indiana University, Department of Surgery, 545 Barnhill Dr., Emerson Hall 203, Indianapolis, IN, 46202, United States
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Trauma Leadership Strategies to Prevent and Reduce Burnout in Urban Academic Trauma Centers. J Trauma Nurs 2017; 24:345-350. [DOI: 10.1097/jtn.0000000000000324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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