Christopher Newman, MBA, PA-C, FCCM
University of Colorado School of Medicine
Aurora, CO
Disclosure information not submitted.
Lauren Sorce, PhD, RN, CPNP-AC/PC
Nurse Scientist/APRN
Ann and Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Disclosure information not submitted.
Sarah Birch, DNP, APRN, CPNP-PC
Assistant Professor of Pediatrics
The George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Amy Scholtz, MSN, WHNP-BC
Manager- Advanced Practice Providers
Children’s Hospital of Philadelphia, United States
Disclosure information not submitted.
Tara Merck, MS, CPNP
Director – CSG Advanced Practice Providers
Children’s Hospital of Wisconsin, United States
Disclosure information not submitted.
Julie Tsirambidis, DNP, APRN-CNP
Director of Advanced Practice Providers
Akron Children’s Hospital, United States
Disclosure information not submitted.
Title: Characterizing within and below scope activities of APPs in 5 PICUs using a novel device and dataset
Introduction: The use of advanced practice providers (APPs) in pediatric intensive care units has been well described. However, the specific activities performed, percentages of time in each activity and time spent in below scope work have not. We performed a multi-center device-based study to quantify this activity and determine how much, if any, below scope activity is taking place.
Methods: Study conducted within the pediatric intensive care units (PICUs) at 5 children’s hospitals. A branching logic dataset was adapted from the Rapid Modeling Corporation’s Time Study RN National Benchmarking Database. The database was programmed into a personal digital assistant (PDA).
Each APP carried the PDA for 1 or more shifts. APP demographic and patient assignment information was collected. The PDA vibrated at random intervals between 10 and 54 minutes and the participant selected the category and activity currently engaged in. For some activities, the participants then identified if the activity was within or below scope of practice. If a selection was not made after the initial alarm, the device would vibrate at 20 second intervals until a selection was made.
Results: 2077 activities were recorded. Most frequent activity categories were documentation (24%), rounds (23%), care planning (14%), assessment (11%) and sign out (7%). Within documentation, most common activities were progress notes (11.4%), orders (5.8%) and transfer summaries (2.4%). 1.48% of activities were identified as below scope, with Intervention- family support (19.2%), Planning- Other (19.2%) and Intervention- airway management (115%) being the most commonly reported, though significant variation existed between institutions (0.36 to 3.1%, p=0.003). The most common nonclinical activities were teaching (4%) and administrative (3%).
Conclusions: PICU APPs spent significant time in documentation and care planning. Documentation specifically has been identified as a driver of provider burnout. In contrast, much less time was spent in activities, such as teaching, associated with resiliency. Time spent in below scope activities represent(s) an opportunity to optimize APP activity by offloading these activities to appropriate personnel.