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The added value of the advanced practice provider in paediatric acute care cardiology

Published online by Cambridge University Press:  04 November 2020

Amanda J. Willis*
Affiliation:
Texas Children’s Hospital, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
Amanda Hoerst
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Stephen A. Hart
Affiliation:
Nationwide Children’s Hospital, Department of Paediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
Diana Holbein
Affiliation:
Department of Paediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Kristyn Lowery
Affiliation:
Department of Paediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
Ashraf S. Harahsheh
Affiliation:
Children’s National Hospital, Department of Paediatrics, The George Washington University School of Medicine, Washington, DC, USA
Alaina K. Kipps
Affiliation:
Lucile Packard Children’s Hospital, Department of Paediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Nicolas Madsen
Affiliation:
Cincinnati Children’s Hospital Medical Center, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Sonali S. Patel
Affiliation:
Children’s Hospital of Colorado, Department of Paediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Ronn E. Tanel
Affiliation:
UCSF Benioff Children’s Hospital, Department of Paediatrics, UCSF School of Medicine, San Francisco, CA, USA
*
Author for correspondence: A. J. Willis, DNP, Texas Children’s Hospital, Department of Paediatrics, 6651 Main Street, Suite E.1920, Houston, TX 77030, USA. Tel: +832-826-5949; Fax: +832-825-9637. E-mail: amjones5@texaschildrens.org

Abstract

Objectives:

Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS).

Study design:

The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson’s correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS.

Results:

Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0–5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001).

Conclusions:

The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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