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Trauma advanced practice provider programme development in an academic setting to optimize care coordination
BACKGROUND: Benchmark data from the Trauma Quality Improvement Program (TQIP) identified an opportunity for improvement in our trauma programme. Our unexpected return to the intensive care unit (ICU) was found to be higher than the national averages and we also noticed that our readmission rate had...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877895/ https://www.ncbi.nlm.nih.gov/pubmed/29766082 http://dx.doi.org/10.1136/tsaco-2016-000068 |
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author | Woodfall, Michelle C Browder, Timothy D Alfaro, Jesus M Claudius, Meghan A Chan, Garrett K Robinson, Denise Greci Spain, David A |
author_facet | Woodfall, Michelle C Browder, Timothy D Alfaro, Jesus M Claudius, Meghan A Chan, Garrett K Robinson, Denise Greci Spain, David A |
author_sort | Woodfall, Michelle C |
collection | PubMed |
description | BACKGROUND: Benchmark data from the Trauma Quality Improvement Program (TQIP) identified an opportunity for improvement in our trauma programme. Our unexpected return to the intensive care unit (ICU) was found to be higher than the national averages and we also noticed that our readmission rate had increased. We chose to address these complications as continuous quality improvement projects. It was hypothesized that restructuring the workflow of the trauma advanced practice providers (APPs) to focus on the delivery of comprehensive clinical care would decrease return to ICU and readmission rates of trauma patients. METHODS: The development of the APP programme occurred from 2012 to 2014. First, APP daily shifts were extended to mirror the resident physicians’ coverage. Second, the APPs’ original job description was expanded from ‘task-oriented’ workflow to providing comprehensive clinical care. Third, the APPs were involved in the evaluation and decision-making process for transferring trauma patients from the ICU. Finally, the APPs implemented a new discharge process that included all information in a standardized format and a follow-up phone call 24–48 hours after discharge. The trauma registry at our verified, academic level I trauma center was use to assess our ICU and hospital readmission rates during the time we instituted the new APP workflow programme. RESULTS: In 2012, our ICU readmission rate was 5.7% (TQIP=1.9%) but then decreased to 4.4% in 2013 (TQIP=2.5%) and 2.1% in 2014 (TQIP=2.8%). Our hospital readmission rate was 2.0% in 2012 but then decreased to 1.38% and 0.96% over the next 2 years. CONCLUSIONS: After extending the APP service coverage, implementing a comprehensive clinical care model and standardizing the discharge process, our unplanned return to ICU rates have decreased to below the TQIP national average and hospital readmission rates have also decreased by half. LEVEL OF EVIDENCE: III. |
format | Online Article Text |
id | pubmed-5877895 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58778952018-05-14 Trauma advanced practice provider programme development in an academic setting to optimize care coordination Woodfall, Michelle C Browder, Timothy D Alfaro, Jesus M Claudius, Meghan A Chan, Garrett K Robinson, Denise Greci Spain, David A Trauma Surg Acute Care Open Original Article BACKGROUND: Benchmark data from the Trauma Quality Improvement Program (TQIP) identified an opportunity for improvement in our trauma programme. Our unexpected return to the intensive care unit (ICU) was found to be higher than the national averages and we also noticed that our readmission rate had increased. We chose to address these complications as continuous quality improvement projects. It was hypothesized that restructuring the workflow of the trauma advanced practice providers (APPs) to focus on the delivery of comprehensive clinical care would decrease return to ICU and readmission rates of trauma patients. METHODS: The development of the APP programme occurred from 2012 to 2014. First, APP daily shifts were extended to mirror the resident physicians’ coverage. Second, the APPs’ original job description was expanded from ‘task-oriented’ workflow to providing comprehensive clinical care. Third, the APPs were involved in the evaluation and decision-making process for transferring trauma patients from the ICU. Finally, the APPs implemented a new discharge process that included all information in a standardized format and a follow-up phone call 24–48 hours after discharge. The trauma registry at our verified, academic level I trauma center was use to assess our ICU and hospital readmission rates during the time we instituted the new APP workflow programme. RESULTS: In 2012, our ICU readmission rate was 5.7% (TQIP=1.9%) but then decreased to 4.4% in 2013 (TQIP=2.5%) and 2.1% in 2014 (TQIP=2.8%). Our hospital readmission rate was 2.0% in 2012 but then decreased to 1.38% and 0.96% over the next 2 years. CONCLUSIONS: After extending the APP service coverage, implementing a comprehensive clinical care model and standardizing the discharge process, our unplanned return to ICU rates have decreased to below the TQIP national average and hospital readmission rates have also decreased by half. LEVEL OF EVIDENCE: III. BMJ Publishing Group 2017-01-27 /pmc/articles/PMC5877895/ /pubmed/29766082 http://dx.doi.org/10.1136/tsaco-2016-000068 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Original Article Woodfall, Michelle C Browder, Timothy D Alfaro, Jesus M Claudius, Meghan A Chan, Garrett K Robinson, Denise Greci Spain, David A Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title | Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title_full | Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title_fullStr | Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title_full_unstemmed | Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title_short | Trauma advanced practice provider programme development in an academic setting to optimize care coordination |
title_sort | trauma advanced practice provider programme development in an academic setting to optimize care coordination |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877895/ https://www.ncbi.nlm.nih.gov/pubmed/29766082 http://dx.doi.org/10.1136/tsaco-2016-000068 |
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