Advanced Practice Providers Play a Critical Role in Acute Specialty Care

Lauren Ingram

Everyone in healthcare is feeling the current strain on the system — a shortage of providers, an increase in seasonal emergency room visits, a nationwide mental health crisis, to name just a few of the challenges. In hospitals across the country, wait times continue to tick up, leaving sick patients grouped together in the waiting room, growing frustrated with both the care team and organization.

In these acute settings, the role of advanced practice practitioners (APPs) is becoming more and more critical to the delivery of quality care, from rural to urban settings, and everywhere in between. Where they are implemented effectively, virtual APPs — as part of an acute telehealth program — enable the highest and best use of a hospital’s clinical staff; meet and respond to the demands of their specialty/service line; allow a hospital to scale and respond to the ever-growing specialist/provider shortage; support consistency of care; and improve hospital-patient communication, such as providing education for post-discharge care.

For many hospitals and health systems, the idea of establishing a large-scale, virtual program might seem overwhelming, but it doesn’t have to be. With the right process and partner(s), it can become a seamless part of your organization’s care delivery model that not only improves patient satisfaction and health outcomes but also your bottom line.

Getting started: Is an acute telemedicine program right for you?

The answer can be found in the data. Many hospitals, especially in rural areas, may find that they are transferring patients to bigger facilities because they don’t have the specialists needed to deliver care. For example, if a hospital does not have a neurologist on staff, they may have to transfer patients who come into the ER with stroke symptoms. Over time, those transfers can be reviewed and quantified to determine whether adding neurology-trained clinicians would benefit both the hospital and patients.

Beyond the hard data, it is valuable to ask the existing care team in what areas they would like additional support. Feedback from the hospitalist, existing nursing staff and other clinicians responsible for the care and oversight of ER patients can shine a light on current gaps and areas for improvement.

With data and feedback in hand, the next step is designing a program that addresses your unique environment and community needs.

Deploying virtual APPs in an acute specialty program

We can’t talk about specialty telemedicine without first addressing regulations. Since each state and hospital is unique, it’s imperative to understand what is and is not allowed based on where you are providing care. Assuming your state’s regulations and hospital’s bylaws support it, the next step is to take internal inventory. Is your organizational culture supportive of a telemedicine program? What about the utilization of APPs — how must they interact with physician leadership and oversight? Executing a successful program requires open communication, a commitment to collaboration, a shared vision of maximum efficiency, and a pledge for candor and transparency. If members of the care team do not work well as partners, a virtual program may be doomed to fail from the start.

Next, get the right people at the table. Depending on your organization’s structure, some of these roles may or may not exist, but this list should provide direction:

• Executive sponsor or lead project manager
• Hospitalists and referring providers
• ED/ICU and nurse director
• Service line-specific lead (e.g., stroke coordinator)
• PACS/imaging director
• CLP/medical staff office

As the program starts to take shape, it is important to confirm (and reconfirm) buy-in across the organization, from the top down and bottom up: the administration, clinicians and nursing staff all must be on board and committed to its success.

From there, you can identify goals, agree on what progress towards those goals looks like, and determine how your organization will measure success.

Enabling successful execution

Like any new directive, deploying virtual APPs in a telemedicine program requires clear roles and responsibilities in order for it to be effective, drive measurable results and make progress towards organizational goals.

Before the first patient is treated, it’s important to clearly define workflows, including:

• Articulate the roles and responsibilities breakdown of the virtual APPs and supervisory virtual specialist physician(s). This will enable the scope of care to rapidly expand in a financially viable way, while also maintaining a clinically excellent quality of care.
• Identify cart coordination ownership and communicate this team-based responsibility.
• Determine the optimal time for the APPs to conduct virtual rounds.
• Document the process for escalation, e.g., how should the APP escalate a case if the primary cart coordinator is busy?
• Determine how the hospital’s layout contributes to (or hinders) efficiency and make a plan accordingly.
• Confirm the equipment needed for each service line.
• Define the process and timeline for regular quality evaluations to take place in concert with the onsite providers.

A recent example demonstrates how important workflows and collaboration are to delivering quality patient care. At a hospital in South Dakota, a patient visited the emergency room complaining of a headache and nausea for the past month. Initial testing did not reveal any significant issues, and the patient was almost discharged. But the virtual APP on duty couldn’t ignore the sense that something was off and ordered the patient to stay for an MRI and a consult with the attending neurologist the next morning. Additional tests revealed the patient was at heightened risk for developing obstructive hydrocephalus and was treated accordingly.

Patients and providers alike deserve the benefits that APPs confer on virtual programs. For patients, they receive consistent care, a well-coordinated and experienced care team, and additional expertise for their unique needs. Providers have a broader bench of experts with whom to consult and on which to rely. Where these programs are in effect, clinicians report lower levels of stress and burnout and higher levels of satisfaction. Like any program in a healthcare setting, an acute telemedicine program with virtual APPs must be purposefully designed, people-centric and have a clear set of measurable goals and key performance indicators. KPIs. With the right planning and execution, the ROI will far exceed expectations.

Lauren Ingram is chief of advanced practice providers at Access TeleCare