Implementation and Evaluation of an Independent Advanced Practice Provider Inpatient Care Model

Background: The addition of advanced practice providers (APPs) has been shown to improve clinical outcomes and patient satisfaction in areas such as ICU, surgery, and transplant; however, there is little evidence that explores such effects in the inpatient hematology-oncology setting. Local Problem: Rapid changes in the healthcare marketplace, such as the growing number of patients, increasing hospital regulations, and adoption of value-based care reimbursement, have pushed healthcare institutions to modify operations in which APPs are utilized. Methods: This project analyzed and evaluated the clinical outcomes, patient satisfaction, and nurse and APP job satisfaction by implementing an independent APP inpatient care model at the Huntsman Cancer Hospital in Salt Lake City, Utah. Analysis was performed using pre- and post-intervention surveys, electronic health medical record (EHMR) chart review, and patient satisfaction scores. Interventions: An independent APP hematology-oncology service was implemented and replaced the traditional academic patient care model. Results: Patient, RN, and APP job satisfaction improved with the implementation of the new service. The APP service had a lower likelihood of pneumonia (p=0.023) and unplanned 30-day readmission (p=0.060) than the academic service. Length of stay was slightly less on the APP service (M=5.84 days) than the academic service (M=7.63 days). There was no statistically significant difference between academic and APP services concerning ICU admissions, CLABSI, CLAUTI, bacteremia/sepsis, COVID-19 infection, DVT/PT, and hospital death. Conclusion: The results of this QI project demonstrate that the independent APP patient care model improved both patient and provider satisfaction while not compromising patient clinical outcomes.