Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program

Krzysztof Laudanski; Ann Marie Huffenberger; Michael J Scott; Justin Wain; Danyal Ghani; C William Hanson 3rd

doi:10.1186/s12913-022-08251-4

Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program

BMC Health Serv Res. 2022 Jul 2;22(1):855. doi: 10.1186/s12913-022-08251-4.

Authors

Krzysztof Laudanski^{1

2

3}, Ann Marie Huffenberger⁴, Michael J Scott⁵, Justin Wain^{6

7}, Danyal Ghani⁸, C William Hanson 3rd⁵

Affiliations

¹ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA. krzysztof.laudanski@pennmedicine.upenn.edu.
² Leonard Davis Institute for Health Economics, Philadelphia, PA, 19104, USA. krzysztof.laudanski@pennmedicine.upenn.edu.
³ Department of Anesthesiology and Critical Care, Leonard Davis Institute for Health Economic, JMB 127; 3620 Hamilton Walk, Philadelphia, PA, 19146, USA. krzysztof.laudanski@pennmedicine.upenn.edu.
⁴ Leonard Davis Institute for Health Economics, Philadelphia, PA, 19104, USA.
⁵ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA.
⁶ School of Osteopathic Medicine, Campbell University, Buies Creek, NC, 27506, USA.
⁷ Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
⁸ College of Art & Sciences, Drexel University, Philadelphia, PA, 19104, USA.

Abstract

Incorporating the advanced practice provider (APP) in the delivery of tele critical care medicine (teleCCM) addresses the critical care provider shortage. However, the current literature lacks details of potential workflows, deployment difficulties and implementation outcomes while suggesting that expanding teleCCM service may be difficult. Here, we demonstrate the implementation of a telemedicine APP (eAPP) pilot service within an existing teleCCM program with the objective of determining the feasibility and ease of deployment. The goal is to augment an existing tele-ICU system with a balanced APP service to assess the feasibility and potential impact on the ICU performance in several hospitals affiliated within a large academic center. A REDCap survey was used to assess eAPP workflows, expediency of interventions, duration of tasks, and types of assignments within different service locations. Between 02/01/2021 and 08/31/2021, 204 interventions (across 133 12-h shift) were recorded by eAPP (n_routine = 109 (53.4%); n_urgent = 82 (40.2%); n_emergent = 13 (6.4%). The average task duration was 10.9 ± 6.22 min, but there was a significant difference based on the expediency of the task (F [2; 202] = 3.89; p < 0.022) and type of tasks (F [7; 220] = 6.69; p < 0.001). Furthermore, the eAPP task type and expediency varied depending upon the unit engaged and timeframe since implementation. The eAPP interventions were effectively communicated with bedside staff with only 0.5% of suggestions rejected. Only in 2% cases did the eAPP report distress. In summary, the eAPP can be rapidly deployed in existing teleCCM settings, providing adaptable and valuable care that addresses the specific needs of different ICUs while simultaneously enhancing the delivery of ICU care. Further studies are needed to quantify the input more robustly.

Keywords: Advance practice providers; ICU; Implementation; Operations; Tele-critical care medicine; Workflow.

MeSH terms

Critical Care*
Hospitals
Humans
Intensive Care Units*
Records
Workflow