Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Mannequins in the Living Room? A Novel Approach to Strengthening PA/NP Teams

10/14/2014 3:54:12 PM | 1 comments

The Affordable Care Act created an influx of newly insured patients against the backdrop of an existing physician shortage. To meet demand and contain costs, many providers are expanding their PA/NP programs — as well as the scope of practice for those professionals.
An example from my own practice: At the Rancho Springs Medical Center Emergency Department (ED) in Murrieta, CA, we recently replaced a physician shift with a PA/NP shift. CEP America felt that increasing the number of PA/NPs on the team would allow it to deliver the same high-quality care while achieving cost savings for our group, hospital and patients. It's exciting that our physicians have placed such trust in us, and we hope that trust will continue to grow as we work together in this challenging setting.
Of course, this change means our PAs are going to be seeing more acute patients and critical cases requiring a life-saving transfer. Given these changes, it’s important that PA/NPs receive all the support they need to safely tackle their expanding responsibilities.
Within our team, we’ve decided to take a fresh approach to PA/NP education and teambuilding by meeting regularly outside the hospital. Not only have we had fun and grown as a team, we feel this approach has many benefits for our hospitals and patients.

New Team, New Challenges

Southwest Healthcare is a two-hospital system. Until recently, the two EDs operated separately. Then, a few years ago, CEP America (which already staffed the ED at Inland Valley Medical Center) was awarded a second contract at Rancho Springs Medical Center. I transferred from Inland to Rancho Springs to become the PA/NP site lead.
The PA/NPs at Rancho Springs had historically not had much autonomy. The new medical directors and I made it a priority to strengthen that program and really get them practicing to their full potential.
I talked to my site lead counterpart Jennine White-Borchert, PA-C, at Inland, and we agreed that unifying the PA/NPs at both sites would enhance patient care in many ways:
  • Getting the teams comfortable with one another would encourage mentoring and collaboration and would help all of us be at our best.
  • Meeting together would allow us to work together toward system-wide process improvement.
  • We wanted to create a welcoming atmosphere for the Rancho Springs providers who were new to the organization.
  • Since most of our PA/NPs would now be working both sites, it was important that everyone have the same clinical and procedural knowledge base. 

A Supportive Environment

In my experience, hospital-based training can be very valuable — but it can also be pretty stressful. In order to be effective in our jobs, PAs and NPs need to maintain the trust of our physicians and teammates. So naturally, we feel a lot of pressure to perform. Sometimes this means we don’t ask important questions or take that extra round of practice for fear of looking foolish. And a high-pressured environment isn't necessarily conducive to strengthening team relationships.
As we looked toward growing our teams' knowledge base, Jennine and I decided that it might be helpful to conduct some of our training outside the hospital — and that physicians, nurses and other interprofessional team members should be included whenever possible.
For our first session, I recruited an ICU nurse to go over ACLS and invited the newly unified team to my house. During our first gathering, the presenter and the group chatted through some scenarios. (What steps do you take when a patient shows signs of stroke? What drug might you administer to a person with symptomatic brachycardia and poor perfusion?) There were no PowerPoints or handouts, just lots of great questions and discussions. Everyone looked relaxed and seemed very engaged with the presenter and one another.
"When’s the next one?" our team members asked afterward.

The Learning Continues

Based on positive feedback from our first meeting, Jennine and I decided to make our out-of-hospital education sessions a quarterly event. We asked the group what topics to prioritize, and they had many suggestions. Several team members also volunteered to host the events.
To date, we’ve met three times, and each has been very well received. In August, emergency physician James Rhee, MD, hosted our group at home and presented on toxicology. (In addition to providing valuable learning opportunities, including doctors and nurses in our meetings has allowed us to really strengthen our interprofessional relationships in the department.)

We also set aside a session for case review and others to practice central line placement and intubation. It was nice to see the participants laughing and practicing over and over without fear of "missing" an intubation. All sessions include time to socialize, and it has been really great to see folks bonding and getting to know one another through these events.

Looking Ahead

In future out-of-hospital meetings, our group plans to work on peer review charts (a department initiative). We’re also working on "booking" a neurosurgeon to talk to us about neurological exams in the ED as well as physicians from orthopedics and other key specialties.
In addition to being a lot of fun for us, we really believe that these informal meetings have many benefits for our hospitals and patients. Our teams have really grown in skill and confidence, especially when it comes to caring for very acute emergency patients. And I really think our collegiality shines through to our patients, which in turn gives them confidence in us.

Jodie Apostle
I definitely agree meeting outside of the hospital takes away the stress of learning or even reviewing topics, the atmosphere is much more relaxed there is no time restraint, easier to ask and answer questions and discuss real issues and cases we have encountered
10/15/2014 7:33:16 AM