Session to explore integration of APPs in nonclinical ICU workflows

Advanced practice providers (APPs) are crucial to multidisciplinary team care in the ICU. But their nonclinical role is often less well-defined. Practices and procedures can vary from one institution to the next, and administrative infrastructures can sometimes shape their contributions in education, triage, and other areas.

Susan Stempek, MBA, MMSc, PA-C, FCCP
Susan Stempek, MBA, MMSc, PA-C, FCCP

“Some physicians, APPs, and other clinicians work in health care systems that have high-functioning APP teams in the ICU, but each hospital is structured differently,” said Session Chair, Susan Stempek, MBA, MMSc, PA-C, FCCP, Vice President of Hospital at Home for Beth Israel Lahey Health, and Critical Care Physician Assistant in Pulmonary and Critical Care at Lahey Hospital & Medical Center. “We are learning that administrative rules and practice requirements that may have been in place for years can get in the way of maximizing the contributions of APPs in the ICU outside of direct clinical care.”

Stempek will chair the session, Integration of APPs in the ICU: A Pro-Con Debate on APP Nonclinical Roles, on Sunday, from 7 am to 8 am, in Room 317B of the convention center. Some topics that will be addressed are educating multidisciplinary team members and trainees, billing for ICU services, and serving as critical care triage clinicians.

“We need to brainstorm the best ways to leverage the expertise of APPs as part of the ICU care team,” Stempek said. “For example, a number of systems have a role by which APPs serve in ICU triage, which can maximize learning of physicians and other trainees by minimizing interruption to structured education. Other systems may learn from the experience of systems doing this well, which in turn could support optimization of evidence-based care delivery to critically ill patients.” 

The session will explore those topics in three discussions. Allison Wynes, ACNP, FCCP, University of Iowa Department of Internal Medicine, and Amy Morris, MD, FCCP, University of Washington Division of Pulmonary, Critical Care, and Sleep Medicine, will kick off the series with a discussion on whether APPs should serve to educate the multidisciplinary team.

Next, Stempek and Todd Rice, MD, FCCP, Vanderbilt University Division of Allergy, Pulmonary and Critical Care Medicine, will address APP coding and billing for clinical services. This subject is complicated by frequently changing billing and coding infrastructure, and, while the speakers are not certified coders, they will speak to their experience as operational leaders.

Lastly, Meghan Kirkland, PA-C, MS, Piedmont Atlanta Hospital, and James Town, MD, University of Washington Division of Pulmonary, Critical Care, and Sleep Medicine, will tackle the question of whether APPs should perform critical care triage. A growing number of institutions are recognizing the value that highly trained APPs can bring to the ICU triage team. “This is a dynamic group of physicians and APPs hosting a session structured to tell the story of how to challenge a health system to do something differently and more effectively to enhance ICU workflows and operations,” Stempek said. “Attendees can expect to hear ideas they can take back to their own organizations and use to update and optimize their own systems to better serve the patients in the ICU.”