Building a 24/7 ICU Intensivist Nurse Practitioner Program“The Vanderbilt Experience”

April N Kapu MSN, RN, ACNP-BC; Clare Thomson-Smith JD, MSN, RN, FAANP; Pam Jones MSN, RN, NEA-BC

Staffing models based on: NP:Patient Ratio 1:8, Total ICU beds, House staff coverage, Patient complexity

Development

ACGME LimitsIncrease in ICU Beds

Reduce LOSImprove ContinuityQuality Imperatives

Leverage MDs to OR/Clinic

Key Drivers Implementation

School of Medicine Department

ICU Medical Director as supervising MD

Physician champions

Faculty appointments

Clinical oversight

Faculty meetings, M&Ms, Grand Rounds

Faculty expectations in:

Education

Research

Patient Care

PLANNING & DUAL OVERSIGHT

COMPREHENSIVE ONBOARDING

Nursing Administration

Staffing models

Funding/financial support

Tracking billing and non billing productivity

Professional practice evaluation program

Recruitment and orientation

Credentialing and privileging

Leadership advancement

Committee involvement

Continuing education

National, state and institutional regulation

Tools for efficiency

Center for Advanced Practice Nursing and Allied Health

Strategic planning

Advanced practice resources

Institutional coordination

Hospital, advanced practice, broad critical care and unit specific orientation checklist

Didactic classroom, self-paced and simulation training modules

Mid and end orientation evaluation

Key Drivers were addressed. NPs provided quality and coverage desired through:

Conclusions

Strategic planning and oversight through both School of Medicine and Advanced Practice Nursing Administration

Streamlined recruitment and hiring process

Support through credentialing and privileging process

Comprehensive onboarding program

Building useful and efficient tools

Tracking billing and non-billing productivity

Opportunities for research and education

Effective professional practice evaluation program

Evaluation

Advanced Practice Provider Professional Practice Evaluation

New hire 6 month evaluation of core competencies

Focused review for new privileges

Focused review required as a result of OPPE

Other need for focused review

FPPE must be time-limited, have proctor assigned and outline plan for improvement

Focused Professional Practice Evaluation FPPE

July

-10

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Feb

-11

Mar

-11

Ap

r-11

May

-11

Jun-

11

Jul-

11

Aug

-11

Sep

-11

Oct

-11

Salary+Fringe

Charges

Collections

$120,000

$100,000

$80,000

$60,000

$40,000

$20,000

$-

BILLING PRODUCTIVITY

Jan-

11

Feb

-11

Mar

-11

Ap

r-11

May

-11

Jun-

11

Jul-

11

Aug

-11

Sep

-11

Oct

-11

1000

800

600

400

200

0

RVUs

Jan-

11

Feb

-11

Mar

-11

Ap

r-11

May

-11

Jun-

11

Jul-

11

Aug

-11

Sep

-11

Oct

-11

46 233 355 194 343 697 573 776 572 504

$1,600,000$1,400,000$1,200,000$1,000,000

$800,000$600,000$400,000$200,000

$-

TECHNICAL CHARGES

TRACKING NP ASSOCIATED QUALITY DATA, UTILIZING ELECTRONIC PROGRESS NOTE

NPS ADDED TO RAPID RESPONSE TEAMS, COLLECTED DATA USING SECURE REDCAP DATABASE

ADULT CRITICAL CARE NPS FORMED SUBSET OF MEDICAL CENTER WIDE ADVANCED PRACTICE SHARED GOVERNANCE MODEL.

NON BILLING PRODUCTIVITYCENSUS TRACKINGEXAMPLE OF ICU WORK TRACKER

EACH ICU TEAM SHARES IN NON-CLINICAL RESPONSIBILITIES

Educational offerings

Training classes

Service updates

Orientation checklists

Protocols

Upcoming conferences

Links to journals

Productivity tracking

ALL INCLUSIVE WEBSITE

Medical Center Wide

The Center for AdvancedPractice and Allied Health

APN LeadershipBoard

Joint Practice & Credentials

Committee

Professional Growth & Development

Committee

Grand RoundsCommittee

ProtocolsCommittee

APN PracticeCouncil

Entity Specific

Vanderbilt UniversityHospital

Critical Care APNCouncil

ContinuingEducationCommittee

VUH APNOrientationCommittee

ProtocolsCommittee

Ongoing Professional Practice Evaluation - OPPEFebruary - April

Can Trigger FPPE

Updates to Professional

Portfolio

Licensure,Certification,Compliance

Chart Audit

Competency Review and

Goals

PrivilegedProcedure

Review

VUMC Credo Evaluation

Attached to Annual

Compensation Adjustments

Ongoing Professional Practice Evaluation - Mid year OPPEAugust - October

Can Trigger FPPE

Updates to Professional

Portfolio

Review of Clinical Outcomes Data

Competency Review

and Goals

Privileged Procedure

Review

Required medical Center Learning

modules and Safety trainingSurgical Intensive Care Unit

ACNP Org Structure

CODE teamimprovement

Rapid ResponseCortrac

VUH Nursing AdministrationCNO- Pam Jones

Assistant Director Advanced PracticeApril Kapu

Department of SurgeryDivision of Surgical Critical Care

Medical DirectorAddison May

Progress noteproject

Skin breakdowninitiative

MDSCC LiaisonPI Liaison

ScheduleOrientation

CC NP LiaisonHypothermia

initiativeNsg. lecture series

Rachel Laurie CarolineKaren EmilyErin MindyKatie

Census trackerProtocols

Proceduresdossier

Protocols