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
