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Schneider S, Stengel D, Seifert J, Ekkernkamp A, Ludwig J. [Perceived utility of the inclusion of physician assistants in the surgical process quality and continuing education in Germany : Results of an interprofessional online survey]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:457-468. [PMID: 38668769 DOI: 10.1007/s00113-024-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Compared to Anglo-American countries, physician assistants (PA) remain an underrepresented professional group within the German healthcare system. In the surgical disciplines, PAs may relieve the administrative burden of doctors by taking on delegable routine tasks, thus creating time and resources for advanced surgical training. OBJECTIVE According to interprofessional experts, can the use of PA lead to an optimization of surgical training and a gain in time for surgical qualification in Germany? MATERIAL AND METHODS After searching for systematic reviews of the current state of knowledge, an online survey was initiated among surgeons and PAs via social networks to determine current and desired clinical areas of activity for PAs in surgery and their future influence on specialist training in Germany. RESULTS A total of nine systematic reviews were identified, suggesting a beneficial impact of PAs on length of stay, direct costs, and treatment outcomes in surgical scenarios. The online survey included 234 surgeons and 114 PAs. Hospitals with ≥ 90 surgical beds employed PAs far more frequently (65%) than smaller institutions (40%). Although both professional groups are generally highly satisfied with the integration of PAs into clinical workflows, there are gradually different opinions about the preferred spectrum of tasks and duties. DISCUSSION PAs would like to have greater responsibility in ordering and interpreting diagnostic tests, communicating with patients, and working in the operating theater. Surgeons are concerned that PAs could replace surgical interns and residents. PAs may enrich healthcare in Germany on various levels and can also improve surgical training. The voice and needs of all professional groups must be considered and respected during the upcoming health system reform.
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Affiliation(s)
- Stephanie Schneider
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland.
| | - Dirk Stengel
- Ressort Medizin, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Deutschland
| | - Julia Seifert
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
| | - Axel Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
- Ressort Medizin, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Deutschland
| | - Johanna Ludwig
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
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Gold A, Wray J, Kosmach-Park B, Bannister L, Wichart J, Graham A, Piotrowski C, Mayersohn G, Shellmer DA, Patterson C. Allied health and nursing practices in pediatric solid organ transplantation: An international survey. Pediatr Transplant 2024; 28:e14541. [PMID: 37550265 DOI: 10.1111/petr.14541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice. METHODS The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free-text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health. RESULTS The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two-thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries. CONCLUSION In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy.
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Affiliation(s)
- Anna Gold
- The Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Beverly Kosmach-Park
- Department of Transplant Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - Louise Bannister
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jenny Wichart
- Department of Pharmacy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ashley Graham
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, The University of Toronto, Toronto, Ontario, Canada
| | - Caroline Piotrowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gillian Mayersohn
- St. Louis Children's Hospital, St. Louis, Missouri, USA
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Diana A Shellmer
- Department of Surgery, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine Patterson
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Department of Rehabilitation Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Parzen-Johnson S, Toia J, Sun S, Patel SJ. Antimicrobial stewardship for nurse practitioners and physician assistants: enhancing patient safety through education. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e165. [PMID: 38028918 PMCID: PMC10644159 DOI: 10.1017/ash.2023.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023]
Abstract
Background As nurse practitioners and physician assistants (APPs) become more prevalent in delivering pediatric care, their involvement in antimicrobial stewardship efforts increases in importance. This project aimed to create and assess the efficacy of a problem-based learning (PBL) approach to teaching APPs antimicrobial stewardship principles. Methods A PBL education initiative was developed after communication with local APP leadership and focus group feedback. It was offered to all APPs associated with Lurie Children's Hospital of Chicago. Participants completed a survey which assessed opinions on antimicrobial stewardship and included knowledge-based questions focused on antimicrobial stewardship. Prescriptions for skin and soft tissue infections associated with APPs were recorded via chart review before and after the education campaign. Results Eighty APPs participated in the initial survey and teaching initiative with 44 filling out the 2-week follow-up and 29 filling out the 6-month follow-up. Subjective opinions of antimicrobial stewardship and comfort with basic principles of AS increased from pre-intervention. Correct responses to knowledge-based assessments increased from baseline after 2-week follow-up (p < 0.01) and were maintained at the 6-month follow-up (p = 0.03). Simple skin and soft tissue infection prescriptions for clindamycin went from 44.4% pre-intervention to 26.5% (p = 0.2) post-intervention. Conclusions A PBL approach for APP education on antimicrobial stewardship can be effective in increasing knowledge and comfort with principles of antimicrobial stewardship. These changes are maintained in long-term follow-up. Changes in prescribing habits showed a strong trend towards recommended empiric therapy choice. Institutions should develop similar education campaigns for APPs.
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Affiliation(s)
| | - Jacquie Toia
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of ChicagoIL60611, USA
| | - Shan Sun
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of ChicagoIL60611, USA
| | - Sameer J. Patel
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of ChicagoIL60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL60611, USA
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Swords KE, Weddle GM, Herigon JC, Stering PD, Lee MS. One size does not fit all: advanced practice provider considerations for the antimicrobial steward. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e139. [PMID: 37663451 PMCID: PMC10468717 DOI: 10.1017/ash.2023.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 09/05/2023]
Abstract
Advanced practice providers are a diverse and established group of antimicrobial prescribers in both ambulatory and inpatient settings. We outline important considerations for antimicrobial stewardship programs and stewards to consider when engaging this important group of providers.
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Affiliation(s)
- Kyleen E. Swords
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gina M. Weddle
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Joshua C. Herigon
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Paula D. Stering
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew S.L. Lee
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Muth BL, Krieger D, Domingo H, Yoo J, Frank A, Paolini K, Mayfield A, Borth A, Siegfried M, McDade H, McCormick N, Hoy H. The current state of transplant advanced practice providers: results of the advanced practice provider practice survey. Am J Transplant 2023; 23:408-415. [PMID: 36695692 DOI: 10.1016/j.ajt.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023]
Abstract
Advanced practice providers (APPs) are trained, licensed health care providers. The American Society of Transplant APP community of practice developed an electronic survey to investigate transplant APP demographics, scope of practice, and academic activities. We defined the top of scope of practice as delivering health care to the fullest extent of APP education and training as allowed by state laws and regulations. From July 11, 2020, to August 31, 2020, 307 invitations were e-mailed and survey links were distributed electronically on the community of practice hub and social media. Two hundred fifty-three APPs responded. APPs practice in inpatient and outpatient settings. Among the respondent APPs, 11.5% assist in the operating room (OR), 46.3% of inpatient and 46.6% of outpatient APPs perform procedures, and 17.8% run specialized APP clinics. 26.2% feel they do not function at the top of their scope of practice and 29.7% were expected to function as a coordinator some or all of the time. Forty-three percent gave invited lectures, 41.5% have published, and 69.2% teach physician trainees. 74.7% and 35.1%, respectively, would like to participate in research and teach but are limited by time, opportunity, and experience. APPs should practice at the top of their scope of practice. Clinical workloads and lack of time limit the ability of APP to teach and contribute to evidence-based practice.
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Affiliation(s)
- Brenda L Muth
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Danielle Krieger
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Hazel Domingo
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Jongwon Yoo
- Division of Nephrology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Anna Frank
- Division of Abdominal Transplant Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen Paolini
- Department of Surgery, Renal Transplant Division, Erie County Medical Center, Buffalo, New York, USA
| | - Allison Mayfield
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Amy Borth
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Margaret Siegfried
- Division of Nephrology and Transplantation, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Heather McDade
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nicole McCormick
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Haley Hoy
- Department of Nursing, University of Alabama Huntsville, Huntsville, AL, USA
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Mahaffey JJ, Selim MA, Kristbaum KA, Mayer J, Martin A, Durazo FA, Hong JC. Evolution of a Transplant Surgery Advanced Practice Provider Practice Model in the Care of High-Acuity Liver Transplant Recipients: A Single-Center Experience. Transplant Proc 2022; 54:2621-2626. [DOI: 10.1016/j.transproceed.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
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Mayer J, Selim MA, Mahaffey JJ, Martin A, Hong JC. Assessment of Patient Knowledge of the Role of Advanced Practice Providers in Transplantation Surgical Care: A Single-Center Prospective Study. Transplant Proc 2022; 54:2616-2620. [DOI: 10.1016/j.transproceed.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
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Nargiso S, Tristan V, Ramos L, Muriel JA, Sachs RE. The evolving role of advanced practice providers in transplantation: a literature review. Curr Opin Organ Transplant 2021; 26:482-487. [PMID: 34369400 DOI: 10.1097/mot.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Solid organ transplantation is a life-saving procedure, often performed in critically ill patients, and advanced practice providers (APPs) have increasingly been incorporated into the multidisciplinary transplant team. A literature review was performed and reinforces the value of transplant APPs, details their evolving roles and responsibilities, and highlights innovative solutions created to address complex problems. RECENT FINDINGS The literature review revealed a deficit of quality quantitative data supporting the utilization of APPs in transplantation. Thus, data regarding the value of APPs in critical care was also analyzed. SUMMARY The limited data despite decades long integration of transplant APPs into the multidisciplinary team, suggests there are likely positive outcomes and innovations that go undocumented. Thus, there are missed opportunities for learning and improvement. Transplant programs investing time and mentorship to support APP research will identify strengths and weaknesses within our existing care models, discover cost saving innovations, and continue to optimize the role of APPs in delivering high quality care that is efficient and evidence based.
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Affiliation(s)
| | | | | | - Jaira A Muriel
- Department of Hepatobiliary and Abdominal Transplant Surgery
| | - Robert E Sachs
- Department of Cardiothoracic Surgery, Keck Hospital of USC, Los Angeles, California, USA
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Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
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Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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