Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative

Abstract

Background: Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams. Local problem: With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers. Methods: Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Interventions: Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Results: Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Conclusions: Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

The effect of primary care clinician type and care team characteristics on health care costs

“…Other care team members included nurses, pharmacists, clinical/medical assistants, integrated behavioural health staff and social workers. A primary principle of the care team design was for all members to be working to the fullest extent of their licensure and training, which has been shown to improve the efficiency of care within the care team 19,20 …”

“…A primary principle of the care team design was for all members to be working to the fullest extent of their licensure and training, which has been shown to improve the efficiency of care within the care team. 19,20 The cost of care was measured with the cost per member per month (PMPM) metric. Every clinician in this study had a panel of patients, and each patient in the panel had a sum of total charges of all services provided for 12 months.…”

Essential collaboration of advanced practice RN roles

“…1, 2 Brooks and Fulton evaluated APRN and physician assistant (PA) practice in an assessment of more than 200 practitioners and concluded that APRNs and PAs are in a unique position to assist with addressing many current challenges in healthcare. 4 The use of collaborative practice models and allowing APRNs to practice to the full extent of their license, training, and education will result in optimal patient outcomes and effectiveness. 4 Another model presented by Waldrop and colleagues supported advanced practice providers including NPs, PAs, and CRNAs, but didn't include CNSs or CNMs in the model for practice.…”

“…4 The use of collaborative practice models and allowing APRNs to practice to the full extent of their license, training, and education will result in optimal patient outcomes and effectiveness. 4 Another model presented by Waldrop and colleagues supported advanced practice providers including NPs, PAs, and CRNAs, but didn't include CNSs or CNMs in the model for practice. 5 APRNs are recognized as key players to drive a more efficient workforce through their capacity to negotiate issues of health and social well-being in a variety of settings, both institutional and community as well as acute and chronic care.…”

An Effective Model for Unit-Based Advanced Practice Provider/Physician Collaboration on a Complex Medicine Hospital Unit

“…Advanced practice providers who practice at the top of their license, education, and scope positively impact healthcare delivery to patients. Numerous studies demonstrate that APP care in the acute care setting has outcomes equivalent to that of physicians [1][2][3][4][5][6] and are associated with decreased complications, length of stay (LOS), and cost of care. 3,7 Advanced practice providers are available to other members of the healthcare team to discuss and provide direction for patient care, and contribute to improvements in continuity of care, access, patient safety/quality, physician productivity, nursing engagement, and patient throughput.…”