B. R. Beaulieu-Jones1, D. P. Croitoru2, R. M. Baertschiger2 1Geisel School Of Medicine At Dartmouth,Hanover, NH, USA 2Dartmouth Hitchcock Medical Center,Pediatric Surgery, Department Of Surgery,Lebanon, NH, USA
Introduction:
The shortage of physician providers, resident work hour limitations and the demonstrated positive impact of advanced providers (AP, nurse practioners, NP, physician assistants, PA and clinical nurse specialists, CNS) on the quality and efficiency of care in numerous specialties have led to broader integration of AP in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 NP coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of AP among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to AP coverage and their impact on patient care, as well as patient and surgeon satisfaction.
Methods:
A fourteen item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N=1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of AP in their practice and their impact on patient care. Descriptive statistics were performed to characterize the function of AP in pediatric surgery practices.
Results:
A total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering “email send out” and “e-mail opening” rates respectively), with 47.6% employed at free standing children’s hospitals and 41.1% employed at a children’s hospital within an adult hospital. Nearly all respondents (N=244, 91.7%) reported the presence of AP in their practice, with NP (N=216) and PA (N=101) most represented. The majority of AP (N=189, 77.8%) covered both general surgery and trauma patients. AP worked nearly equally in the out- (N=219, 89.8%) and in-patient settings (N=232, 95.1%), and less often in the neonatal (N=131) or pediatric (N=126) intensive care units. 15% of surgeons (N=40) reported that AP provided 24/7 coverage within their practice. Surgeons reported that AP had a very positive (75%) or positive (21%) impact on their practice, with none reporting a negative impact. AP also had a very positive (74%) or positive (21%) impact on patient satisfaction. The main area in which surgeons reported the most significant impact of AP was continuity of care (N=77), efficiency of service (N=66) and education of parents and patients (N=53).
Conclusion:
Pediatric surgical practices of all types are broadly utilizing AP. The integration of AP across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service. AP likely represent part of the solution to delivering quality care in current delivery systems.