east advanced practitioner survey
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EAST Advanced EAST Advanced PractitionerPractitioner
SurveySurvey
Martin D. ZielinskiMartin D. ZielinskiAdvanced Practitioners Advanced Practitioners
CommitteeCommitteeJanuary 20, 2010January 20, 2010
Why are APs in Demand?Why are APs in Demand? Increased need for advanced Increased need for advanced
practitioners (AP)practitioners (AP) 80 hour work week for residents80 hour work week for residents
Resident goal clearResident goal clear AP goals less clear and variableAP goals less clear and variable
PayPay Life-work balanceLife-work balance EducationEducation AdministrationAdministration
GoalsGoals Develop “best practice” modelDevelop “best practice” model
SatisfactionSatisfaction RetentionRetention Appropriate patient careAppropriate patient care
Meet AP needsMeet AP needs
Nurse Practitioners and Physician Nurse Practitioners and Physician Assistants considered equivalent for Assistants considered equivalent for
purposes of this reportpurposes of this report
Job DescriptionJob Description 242 total responses242 total responses
70% Surgeons70% Surgeons 19% Advanced 19% Advanced
PractitionerPractitioner 10% Trauma 10% Trauma
CoordinatorCoordinator
ACS LevelACS Level
The “Typical” ACS Advanced The “Typical” ACS Advanced Practitioner:Practitioner:
Works on the Trauma floor service (95.4%)Works on the Trauma floor service (95.4%) Cares for 6 – 10 (42%) patients per shiftCares for 6 – 10 (42%) patients per shift Takes no call (71.4%)Takes no call (71.4%) Has similar responsibilities to a junior resident Has similar responsibilities to a junior resident
(57.3%)(57.3%)
Advanced Practitioner Area Advanced Practitioner Area of Practiceof Practice
Staffing Use on Acute Care Staffing Use on Acute Care Surgical ServicesSurgical Services
Advanced Advanced PractitionerPractitioner ResidentResident
Trauma Trauma ServiceService 78.9%78.9% 81.2%81.2%
SICUSICU 50.4%50.4% 72.1%72.1%General General SurgerySurgery 36.4%36.4% 64.0%64.0%Combine Combine Trauma/ICUTrauma/ICU 32.6%32.6% 63.4%63.4%
AP Staffing LevelAP Staffing Level
SurgeonSurgeon APAP
InterchangeaInterchangeable (Junior)ble (Junior) 20%20% 23%23%
InterchangeaInterchangeable (Senior)ble (Senior) 8%8% 21%21%
Independent Independent StaffingStaffing 64%64% 54%54%
Advanced Practitioner Advanced Practitioner Common Floor Common Floor ResponsibilitiesResponsibilitiesDaily NoteDaily Note 81.4%81.4%D/c D/c SummarySummary 88.7%88.7%Care Care CoordinatioCoordinationn
93.3%93.3%
Phone CallsPhone Calls 69.1%69.1%
Procedure PerformanceProcedure PerformanceCertifiedCertified Routinely PerformRoutinely Perform
Central LineCentral Line 86%86% 63%63%PA CatheterPA Catheter 89%89% 44%44%BronchoscopyBronchoscopy 76%76% 71%71%PEGPEG 75%75% 73%73%Perc TrachPerc Trach 82%82% 67%67%LacerationsLacerations 83%83% 66%66%EGDEGD 79%79% 50%50%FAST/DPLFAST/DPL 71%71% 73%73%Chest TubeChest Tube 88%88% 61%61%IntubationIntubation 89%89% 47%47%
OR PresenceOR Presence
AP RoleAP RoleResidenResiden
t t PresentPresent
No No ResidenResiden
ttOverallOverall 37%37% 77%77%11stst AssistAssist 25%25% 48%48%22ndnd AssistAssist 12%12% 29%29%
Other ResponsibilitiesOther Responsibilities
Areas EAST May ImpactAreas EAST May Impact Strategic PlanStrategic Plan Plan AP billing seminarPlan AP billing seminar ATLS for APs (they’re in the trauma ATLS for APs (they’re in the trauma
bay!)bay!) Full EAST membershipFull EAST membership Recommend AP geared conferencesRecommend AP geared conferences
Areas EAST May ImpactAreas EAST May Impact Garner further knowledgeGarner further knowledge
Refine surveyRefine survey AP specific societyAP specific society
Practice Management GuidelinePractice Management Guideline National StandardsNational Standards RetentionRetention
Other manuscriptsOther manuscripts EnthusiasmEnthusiasm
5-7 minutes5-7 minutes Brief intro and brief summaryBrief intro and brief summary Where they’re used (scope in Jan 2010) – floor, ICU (everywhere!)Where they’re used (scope in Jan 2010) – floor, ICU (everywhere!) What they do – procedures, charting, etc…What they do – procedures, charting, etc… Decide these at EAST meeting:Decide these at EAST meeting:
?PMG for APs?PMG for APs Retention for a future discussionRetention for a future discussion ? Subcommittee's? Subcommittee's Mission statement goalsMission statement goals Discuss to expand AP to allow EAST membershipDiscuss to expand AP to allow EAST membership ?ACS AP accredidation?ACS AP accredidation 2-3 good projects (high impact)2-3 good projects (high impact)
BackgroundBackground Increased need for advanced Increased need for advanced
practitioners (AP)practitioners (AP) 80 hour work week for residents80 hour work week for residents
Resident goal clearResident goal clear AP goals less clear and variableAP goals less clear and variable
PayPay Life-work balanceLife-work balance EducationEducation AdministrationAdministration
BackgroundBackground Develop a modelDevelop a model
SatisfactionSatisfaction RetentionRetention Appropriate Patient CareAppropriate Patient Care
NPs and PAs considered equivalent NPs and PAs considered equivalent for purposes of this reportfor purposes of this report
Survey AudienceSurvey Audience
Job DescriptionJob Description 242 total responses242 total responses
70% Surgeons70% Surgeons 19% Advanced 19% Advanced
PractitionerPractitioner 10% Trauma 10% Trauma
CoordinatorCoordinator
ACS LevelACS Level
Trauma VolumeTrauma Volume
Advanced Practitioner and Advanced Practitioner and Resident Staffing and Resident Staffing and
InteractionInteraction
Staffing Use on Acute Care Staffing Use on Acute Care Surgical ServicesSurgical Services
Advanced Advanced PractitionerPractitioner ResidentResident
Trauma Trauma ServiceService 78.9%78.9% 81.2%81.2%
SICUSICU 50.4%50.4% 72.1%72.1%General General SurgerySurgery 36.4%36.4% 64.0%64.0%Combine Combine Trauma/ICUTrauma/ICU 32.6%32.6% 63.4%63.4%
Trauma Staffing per ACS Trauma Staffing per ACS LevelLevel
Advanced Advanced PractitionerPractitioner ResidentResident
Level 1Level 1 80.7%80.7% 92.7%92.7%
Level 2Level 2 79.5%79.5% 42.9%42.9%
Level 3Level 3 50.0%50.0% 0%0%
Level 4Level 4 0%0% 0%0%
Trauma Staffing per Trauma Trauma Staffing per Trauma VolumeVolume
Patient Patient VolumeVolume
Advanced Advanced PractitionerPractitioner
ResidentResident
<1000<1000 66.7%66.7% 53.6%53.6%
1000 – 18001000 – 1800 80.0%80.0% 68.8%68.8%
1801 – 35001801 – 3500 80.6%80.6% 93.6%93.6%
3500+3500+ 83.7%83.7% 92.5%92.5%
Surgeon vs AP View of Surgeon vs AP View of Responsibility LevelResponsibility Level
Attending Attending SurgeonSurgeon APAP
Medical Medical StudentStudent 0%0% 5%5%Junior Junior ResidentResident 66%66% 23%23%Senior Senior ResidentResident 31%31% 57%57%StaffStaff 3%3% 17%17%
AP Staffing LevelAP Staffing LevelSurgeonSurgeon APAP
InterchangeaInterchangeable (Junior)ble (Junior)
20%20% 23%23%
InterchangeaInterchangeable (Senior)ble (Senior)
8%8% 21%21%
Independent Independent StaffingStaffing
64%64% 54%54%
Resident and AP InteractionResident and AP Interaction When residents are present:When residents are present:
Similar number of APs per shift (3.2 vs. 2.6)Similar number of APs per shift (3.2 vs. 2.6) Same patient load responsibility (6-10)Same patient load responsibility (6-10) Similar rate of bedside proceduresSimilar rate of bedside procedures Less OR responsibility (48% vs. 18%)Less OR responsibility (48% vs. 18%) Less number of APs per night call (0.7 vs. Less number of APs per night call (0.7 vs.
0.3)0.3)
Advanced Practitioner Advanced Practitioner Scope of PracticeScope of Practice
The “Typical” Advanced The “Typical” Advanced Practitioner:Practitioner:
Works on the Trauma floor service (95.4%)Works on the Trauma floor service (95.4%) Cares for 6 – 10 (42%) patients per shiftCares for 6 – 10 (42%) patients per shift Takes no call (71.4%)Takes no call (71.4%) Has similar responsibilities to a junior resident Has similar responsibilities to a junior resident
(57.3%)(57.3%)
Advanced Practitioner Area Advanced Practitioner Area of Practiceof Practice
Advanced Practitioner Advanced Practitioner Partners Per ShiftPartners Per Shift
Total Total PartnersPartners
DaytimeDaytimeShiftShift
NighttimNighttimee
WeekenWeekend or d or
HolidayHoliday
TraumaTrauma 3.23.2 2.12.1 0.40.4 0.80.8
SICUSICU 3.03.0 1.41.4 0.30.3 0.60.6
Acute Acute SurgerySurgery 2.62.6 1.11.1 0.20.2 0.30.3
Advanced Practitioner Advanced Practitioner Partners per Shift ViewpointPartners per Shift Viewpoint
Surgeon ViewSurgeon View AP ViewAP View
TraumaTrauma 2.82.8 4.34.3
ICUICU 2.52.5 3.53.5
Trauma/ICUTrauma/ICU 2.22.2 5.35.3
Acute SurgeryAcute Surgery 1.51.5 2.52.5
Advanced Practitioner CallAdvanced Practitioner Call
If APs do take call, 84.4% are in houseIf APs do take call, 84.4% are in house If residents are present, there is less AP call (24% vs. 45%)If residents are present, there is less AP call (24% vs. 45%)
NoneNone 72%72%On houseOn house 17%17%HomeHome 1%1%BackupBackup 3%3%
Advanced Practitioner Advanced Practitioner Common Floor Common Floor ResponsibilitiesResponsibilitiesDaily NoteDaily Note 81.4%81.4%D/c D/c SummarySummary 88.7%88.7%Care Care CoordinatioCoordinationn
93.3%93.3%
Phone CallsPhone Calls 69.1%69.1%
Procedure PerformanceProcedure PerformanceCertifiedCertified Routinely PerformRoutinely Perform
Central LineCentral Line 86%86% 63%63%PA CatheterPA Catheter 89%89% 44%44%BronchoscopyBronchoscopy 76%76% 71%71%PEGPEG 75%75% 73%73%Perc TrachPerc Trach 82%82% 67%67%LacerationsLacerations 83%83% 66%66%EGDEGD 79%79% 50%50%FAST/DPLFAST/DPL 71%71% 73%73%Chest TubeChest Tube 88%88% 61%61%IntubationIntubation 89%89% 47%47%
Procedure Performance Procedure Performance PerceptionPerception
SurgeonSurgeon APAPCentral LineCentral Line 42%42% 42%42%PA CatheterPA Catheter 29%29% 41%41%BronchoscopyBronchoscopy 50%50% 45%45%PEGPEG 45%45% 49%49%Perc TrachPerc Trach 45%45% 50%50%LacerationsLacerations 47%47% 35%35%EGDEGD 40%40% 42%42%FAST/DPLFAST/DPL 48%48% 52%52%Chest TubeChest Tube 38%38% 43%43%IntubationIntubation 37%37% 32%32%
OR PresenceOR Presence
AP RoleAP RoleResidenResiden
t t PresentPresent
No No ResidenResiden
ttOverallOverall 37%37% 77%77%11stst AssistAssist 25%25% 48%48%22ndnd AssistAssist 12%12% 29%29%
BillingBilling
SurgeonSurgeon APAPIndependent Independent Billing Billing ViewpointViewpoint
47%47% 3131%%
37% of surgeons believe APs perform procedure notes while 92%of APs state they do
Other ResponsibilitiesOther Responsibilities
RetentionRetention
RetentionRetention
33% > 5 years33% > 5 years
63% leave at 2 – 4 years63% leave at 2 – 4 years
Retention is a problem!Retention is a problem!
Retention - IncentivesRetention - IncentivesSurgeonSurgeon APAP
Differential Differential Shift PayShift Pay 22%22% 33%33%
Time OffTime Off 58%58% 61%61%Paid Paid Conference Conference AttendanceAttendance
51%51% 80%80%
Paid CMEPaid CME 51%51% 83%83%Pay per Years Pay per Years of Experienceof Experience 37%37% 38%38%
BonusesBonuses 23%23% 21%21%ProceduresProcedures 45%45% 50%50%
RetentionRetention Institutional incentives offeredInstitutional incentives offered
AP desires?AP desires? Work-Life balanceWork-Life balance
Time offTime off CallCall
EducationEducation
APs Want To Be Educated!APs Want To Be Educated!
75% attend in-house conferences 75% attend in-house conferences geared towards surgical residentsgeared towards surgical residents
19% attend in-house AP geared sessions19% attend in-house AP geared sessions Only 62% undergo orientationOnly 62% undergo orientation Average orientation 4-5 weeksAverage orientation 4-5 weeks 71% attend paid conferences71% attend paid conferences
SummarySummary
Trauma services seem to be more Trauma services seem to be more robust and experiencedrobust and experienced Can use trauma as a model to push the Can use trauma as a model to push the
other services forward in practiceother services forward in practice Must be careful as there seems to be Must be careful as there seems to be
poor retention at the year 2-4 levelpoor retention at the year 2-4 level
SummarySummary Institutional practiceInstitutional practice
Clearly insufficient retentionClearly insufficient retention
Future DirectionsFuture Directions Can we develop a model for each Can we develop a model for each
ACS level? ACS level? Each center is differentEach center is different
Resident availabilityResident availability VolumeVolume ACS level (i.e. acuity)ACS level (i.e. acuity)
Areas EAST May ImpactAreas EAST May Impact Plan AP billing seminarPlan AP billing seminar ATLS for APs (they’re in the trauma bay!)ATLS for APs (they’re in the trauma bay!) Recommend AP geared conferencesRecommend AP geared conferences Garner further knowledgeGarner further knowledge
Refine surveyRefine survey AP specific societyAP specific society Trial?Trial?
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