Dataset Information

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis.

ABSTRACT:

Purpose

In a time of worldwide physician shortages, the advanced practice providers (APPs) might be a good alternative for physicians as the leaders of a rapid response team. This retrospective analysis aimed to establish whether the performance of APP-led rapid response teams is comparable to the performance of rapid response teams led by a medical resident of the ICU.

Material and methods

In a retrospective single-center cohort study, the electronic medical record of a tertiary hospital was queried during a 12-months period to identify patients who had been visited by our rapid response team. Patient- and process-related outcomes of interventions of rapid response teams led by an APP were compared with those of teams led by a medical resident using various parameters, including the MAELOR tool, which measures the performance of a rapid response team.

Results

In total, 179 responses of the APP-led teams were analyzed, versus 275 responses of the teams led by a resident. Per APP, twice as many calls were handled than per resident. Interventions of teams led by APPs, and residents did not differ in number of admissions (p = 0.87), mortality (p = 0.8), early warning scores (p = 0.2) or MAELOR tool triggering (p = 0.19). Both groups scored equally on time to admission (p = 0.67) or time until any performed intervention.

Conclusion

This retrospective analysis showed that the quality of APP-led rapid response teams was similar to the quality of teams led by a resident. These findings need to be confirmed by prospective studies with balanced outcome parameters.

SUBMITTER: Kreeftenberg HG

PROVIDER: S-EPMC9398002 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis.

Kreeftenberg Herman G HG De Bie Ashley J R AJR Mestrom Eveline H J EHJ Bindels Alexander J G H AJGH van der Voort Peter H J PHJ

PloS one 20220823 8

<h4>Purpose</h4>In a time of worldwide physician shortages, the advanced practice providers (APPs) might be a good alternative for physicians as the leaders of a rapid response team. This retrospective analysis aimed to establish whether the performance of APP-led rapid response teams is comparable to the performance of rapid response teams led by a medical resident of the ICU.<h4>Material and methods</h4>In a retrospective single-center cohort study, the electronic medical record of a tertiary ...[more]

PMID: 35998147

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Project description:BackgroundAdvanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.MethodsWe conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).ResultsWe identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.ConclusionsWe summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Project description:ObjectiveThis study investigated the effectiveness and tolerability of brivaracetam (BRV) monotherapy in a large series of patients with epilepsy.MethodThis was a multicenter, retrospective, observational, non-interventional study in 24 hospitals across Spain. Patients aged ≥18 years who started on BRV monotherapy, either as first-line or following conversion, at least 1 year before database closure were included. Patients were evaluated at baseline and at 3, 6 and 12 months after initiation of BRV monotherapy, in accordance with usual clinical practice at these centers. Data were collected retrospectively from patients' individual charts by participating physicians. The primary effectiveness and safety endpoints were the percentage of seizure-free patients 1 year after initiation of BRV monotherapy and the proportion of patients reporting adverse events (AEs) over the complete follow-up period. Retention rates and subpopulation analysis (levetiracetam switchers, elderly and different etiologies) were also investigated.ResultsA total of 276 patients were included (48 with BRV as first-line monotherapy and 228 who converted to BRV monotherapy). The overall retention rate in monotherapy at 12 months was 89.9% (87.5% for first-line monotherapy group; 90.4% for conversion-to-monotherapy group). Seizure-freedom rates at 12 months were 77.8% (75% for first-line monotherapy group; 78.4% for conversion-to-monotherapy group). AEs occurred in 39.5% of patients at 12 months (35.4% for first-line monotherapy group; 40.4% for conversion-to-monotherapy group). Most AEs were mild-to-moderate. The most frequent AEs were irritability (12.3%) and dizziness (10.1%). The most frequent AEs leading to BRV withdrawal were dizziness (1.8%) and memory problems (1.4%). Similar outcomes in terms of effectiveness and tolerability of BRV monotherapy were observed in patients switching from levetiracetam, those with different epilepsy etiologies, and elderly patients.SignificanceBRV was effective and well tolerated both as first-line monotherapy and following conversion to monotherapy in a real-world setting of patients with epilepsy.Plain language summaryThe goal of the medical treatment of epilepsy is to ensure best possible patient quality of life, by maximizing seizure control and minimizing medication toxicity. Brivaracetam (BRV) is a new-generation epilepsy treatment that is well tolerated by patients. In our study, monotherapy with BRV reduced seizures in patients who had not received other treatments and in patients who switched from a previous treatment to BRV monotherapy. BRV was well tolerated and also effective in sensitive patients (i.e., the elderly and those who had epilepsy caused by a brain tumor or a brain injury).

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Project description:BackgroundAdvanced Practice Nursing (APN) is evolving across the Middle East, including in Saudi Arabia. However, limited knowledge exists regarding the facilitators and barriers to APN programs and role implementation in the region. This study utilizes a descriptive exploratory qualitative approach to examine the perspectives of academic nurse leaders on APN in Saudi Arabia.MethodsThis study used a descriptive qualitative design. Semi-structured interviews were conducted with 13 academic leaders from various academic institutions across Saudi Arabia over six months in 2022 and 2023 via Zoom. Audio recordings were transcribed using NVivo. Thematic analysis identified several key themes.ResultsThe Description of APN theme highlighted specialized clinical skills, autonomous practice, and varied roles. The Needs theme emphasized improving patient outcomes, supporting healthcare transformation, and increasing cost-efficiency. The Current Status theme noted APN's infancy and limited academic programs in Saudi Arabia. Differences in APN roles theme revealed specific functions and regional variations within the healthcare system. The Focus of APN Education theme emphasized the need for all specialties. Recommended admission requirements for the APN program included a bachelor's degree and two years of experience. The Challenges theme included organizational and regulatory factors, such as organizational access to resources, and regulatory facilitators included supportive laws. The APN Future theme revealed an optimistic yet challenging outlook.ConclusionsAcademic nurse leaders consider APN essential for improving patient outcomes, requiring supportive laws, collaboration, expert involvement, and resource allocation to establish robust APN programs, offering insights for similar global contexts. This study identified challenges and facilitators of implementing APN roles and highlighted actionable steps for various stakeholders to enhance the integration of APNs. The perspectives of academic nurse leaders provide actionable recommendations to highlight the requirements for APN roles, admission to the educational programs, challenges and facilitators to assist APNs in practicing at their full potential, ultimately improving patient health outcomes by shaping the future of nursing education, practice, and regulation adjustments.Clinical trial numberNot applicable.

Dataset Information

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis.

Purpose

Material and methods

Results

Conclusion

Publications

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis.

Similar Datasets

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