Trauma and Critical Care Team Skills Program: A Program Evaluation

Background: Advanced Practice Providers (APPs) do not receive formal education in invasive skills before graduation despite the critical skills incorporation of required skills performance in critical care and trauma settings throughout the United States. As APPs utilization increases, so will the need for invasive skills training. Physicians who traditionally perform these skills receive extensive training before board certification. This program evaluation aims to evaluate current training standards for critical care and trauma APPs in invasive skills at a large healthcare system in the Mountain West. Local Problem: Patient outcomes are negatively impacted when APPs lack education and training in invasive skills. APPs confidence is also adversely affected, leading to poor job satisfaction and migration to other roles that do not require these skills. APPs have stated frustration in lack of training during orientation and lack of competence definition generally. In this hospital system, the APPs say they did not receive formal skills training before or during their orientation. Methods: This project used the Kirkpatrick Model and the Centers for Disease Control and Prevention program evaluation framework to identify current training and competency definitions in skills performance for APPs. Stakeholders were identified through word of mouth and open-ended interviews conducted about the current skills training program. Interview findings were summarized in an executive summary and presented to the stakeholders along with evidence-based suggestions to improve training and evaluation. A final executive summary summarized stakeholder feedback about the findings and evidence-based suggestions. Interventions: There were no interventions for this program evaluation. Results: Data gathered demonstrated inconsistent training in invasive skills. Most APPs interviewed could not recall what educational standard or number of specific skills constituted competency. Stakeholders state understanding that training is inconsistent with evidence-based suggestions and state financial investment in training as the biggest obstacle to implementing evidence-based recommendations. Other obstacles include APPs desire and initiative, lack of competency definition, and available resources. Conclusion: While invasive skills performance is becoming increasingly necessary for critical care APPs, there is no uniform standard for education or competency. In this setting, APPs state uncertainty about requirements, and a majority state a need for more confidence in skills performance. While physician oversight is available, many physicians similarly state uncertainty about APP competency in skills performance.