Weimer, John W.

ABSTRACT Background: Successful use of nurse practitioner (NP) and physician assistant (PA) care models is vital to delivering optimal patient care, maintaining financial stability, and reducing staff burnout and turnover. Local Problem: A large cardiovascular surgery practice experienced substantial growth, leading to an obsolete NP and PA care model. Consequently, workplace satisfaction scores were reduced, and the NP and PA turnover rate in 2018 was unacceptably high. Methods: A multidisciplinary redesign team was formed to address gaps in the care model through a quality-improvement initiative. The team analyzed current workflows, collected external and internal survey data, conducted patient tracers, and observed staff. Seventeen collaborative care models were proposed by frontline staff members and presented to their peers for feedback. This feedback was used to select the best aspects of the proposed models to create a new model. Interventions: The updated care model consisted of several key changes, which included reducing NP- and PA-to-patient ratios, eliminating redundant tasks, shifting from location-based to surgical team–based coverage, ensuring top-of-scope practice, developing specialty service lines, and separating inpatient and outpatient practices. Results: After implementation of the new care model, NP and PA turnover rates decreased from baseline by an average of approximately 74% per year. Departmental work culture scores concomitantly increased from 68% to 85% after implementation of the new care model. Conclusions: Adapting care models in conjunction with departmental growth is crucial to enhancing staff satisfaction and reducing burnout.

Objectives To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). Design Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. Setting A large tertiary referral academic cardiac surgery ICU. Participants There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. Interventions Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. Measurements and Main Results Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort ( P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort ( P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% ( P = .30). Conclusions Overall, implementation of an NP/PA-led postcardiac surgical ICU team ( rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.