JL530. The Creation and Sustainability of an Effective After-Hours Coverage Model Utilizing Advanced Practice Providers
LaKeisha Day, PA-C, CMQ, Anayo Mbadugha, PA-C, and Todd Pickard, MMSc, PA-C, DFAAPA; The University of Texas MD Anderson Cancer Center, Houston, Texas
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JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
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Background: Located in Houston’s Texas Medical Center, The University of Texas MD Anderson Cancer Center is a comprehensive cancer hospital that provides treatment at various stages of oncologic care. It is the largest oncology specialty hospital in the United States, with over 600 inpatient beds, 4 satellite locations around the city and over 25 affiliated entities within the US and internationally. With the exception of nursing staff, there were no full-time clinical staff members dedicated to after-hours patient care necessities. After-hours coverage for the entire hospital was provided by three oncology fellows and one medical resident, assigned to cover various oncology areas. This coverage model for such a large and complex patient population resulted in concerns for patient safety.
Intervention: In 2009, a 24-hour task force was formed to analyze the concerns and limitations of the current state of after-hour coverage and propose a way forward in providing after-hours coverage to suit the needs of the patients. The deliberations of the task force resulted in the creation of the Nocturnal Program. Launched February 8, 2011, with two full-time advanced practice providers (APPs) and a pool of 25 moonlighting physicians, the areas of most critical need were identified and coverage was assigned to the medical and surgical intensive care units, and one leukemia unit.
Outcome: By the end of 2011, the program consisted of 7 full-time APPs and 40 moonlighters, and has since grown into what is now one of the larger APP programs in the hospital, with 32 APPs and over 120 moonlighters. The hospital after-hours coverage expanded from seven providers to the current model of at least 21 providers every night of the week. As the hospital opened new coverage areas, the needs for patient care coverage were anticipated and the coverage models were adapted, including recently adding coverage for the pediatric transplant and intensive care units and the creation of an APP-run observation unit.
Summary: Although the creation of after-hours patient care models is not unique, the growth of the program in such a short time span can be attributed to a number of factors. The program was created independently from existing programs and utilized full-time APPs as first-line providers with moonlighting physicians serving as back-up. This team-based approach works because of the regulatory landscape in Texas, which due to generous collaboration and delegation laws, allows APPs to work with a high degree of autonomy.
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