PAs, NPs shoulder bulk of blood/marrow transplant patient care

Advanced practice practitioners covered the majority of direct, first-line care at four Seattle facilities.

PAs, NPs shoulder bulk of blood/marrow transplant patient care
PAs, NPs shoulder bulk of blood/marrow transplant patient care

BOSTON — Certified physician assistants  and advanced registered nurse practitioners are important players in delivering high-quality, first-line care to patients undergoing blood/marrow transplants, according to researchers.

Marc Matsui, PA-C, MMSc,  and colleagues from the Fred Hutchinson Cancer Research Center (FHCRC), the University of Washington Cancer Consortium,  the Seattle Cancer Care Alliance and Seattle Children's Hospital attempted to quantify the workload contribution of full-time and part-time certified PAs and ARNPs from July 2011 to June 2012.

During the time period examined, 422 adult patients and 63 pediatric patients received a blood/marrow transplant. Overall, 36 full-time or part-time PAs and ARNPs provided dedicated, direct care for these patients. The findings were highlighted in a poster presented at the American Academy of Physician Assistants IMPACT 2014 meeting.

Staffing assignments showed that advanced practice practitioners (AAPs) covered the majority of direct, first-line care during daytime hours (defined as 8:00 a.m. to 5:00 p.m.) and overnight hours (5:00 p.m. to 8:00 a.m.), seven days a week, for adult and pediatric patients undergoing blood/marrow transplant at the four Seattle facilities.

As of July 2012, all scheduled overnight coverage was provided solely by APP hospitalists. Attending physicians generally were not present but were available by pager.

Outpatients were cared for at the Seattle Cancer Care Alliance clinic, adult inpatients were cared for at the University of Washington Medical Center, and pediatric inpatients were cared for at Seattle Children's Hospital.

Front-line care of blood/marrow transplant patients at FHCRC historically has been provided by APPs  and hematology/oncology fellows, the researchers noted.

 The APP staff is permanently dedicated to this patient population, with fellows working in two-month rotations: one month in the inpatient clinic and one month in the outpatient clinic.

Board-certified attending physician faculty members supervise the APPs and fellows, who perform tasks including:

  • Comprehensive history-taking and physical examinations
  • Initial ordering of chemotherapy (subsequently verified by faculty, pharmacists and nurses)
  • Daily management of patients who change from clinically well and stable to intubated and in the intensive care unit

However, APPs no longer participate in the direct, first-line overnight care of pediatric inpatients undergoing blood/marrow transplant through FHCRC, the researchers noted.  A single physician hospitalist covers this group, in accordance with a 2010 change in staffing model.    

Reference

  1. Matsui M, Levy W, Stewart FM. Poster #122. “Utilization of advanced practice providers caring for patients undergoing blood and marrow transplantation.” Presented at: IMPACT 2014. Boston; May 23-28, 2014.
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