Stanford Advisors

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  • Service Value Activities by Nurse Practitioners in Ambulatory Specialty Care. Policy, politics & nursing practice Winter, S. G., Duderstadt, K., Chan, G. K., Spetz, J., Stephan, L. M., Matsuda, E., Chapman, S. A. 2020: 1527154420927689


    The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.

    View details for DOI 10.1177/1527154420927689

    View details for PubMedID 32486957

  • PPE Portraits-a Way to Humanize Personal Protective Equipment. Journal of general internal medicine Brown-Johnson, C., Vilendrer, S., Heffernan, M. B., Winter, S., Khong, T., Reidy, J., Asch, S. M. 2020


    The use of personal protective equipment (PPE) has skyrocketed, as providers don masks, glasses, and gowns to protect their eyes, noses, and mouths from COVID-19. Yet these same facial features express human individuality, and are crucial to nonverbal communication. Isolated ICU patients may develop "post intensive-care syndrome," which mimics PTSD with sometimes debilitating consequences. While far from a complete solution, PPE Portraits (disposable portrait picture stickers- 4" * 5") have the potential to humanize care. Preparing for a larger effectiveness evaluation on patient and provider experience, we collected initial qualitative implementation insights during Spring 2020's chaotic surge preparation. Front-line providers reported more comfort with patient interactions while wearing PPE Portraits: "It makes it feel less like a disaster zone [for the patient]." A brief pilot showed signs of significant adoption: a participating physician requested PPE Portraits at their clinic, shift nurses had taken PPE Portraits with them to inpatient services, and masked medical assistant team-members requested PPE Portraits to wear over scrubs. We believe PPE Portraits may support patient care and health, and even potentially healthcare team function and provider wellness. While we await data on these effects, we hope hospitals can use our findings to speed their own implementation testing.

    View details for DOI 10.1007/s11606-020-05875-2

    View details for PubMedID 32410125

  • Measurement of nonbillable service value activities by nurse practitioners, physician assistants, and clinical nurse specialists in ambulatory specialty care. Journal of the American Association of Nurse Practitioners Winter, S. n., Chan, G. K., Kuriakose, C. n., Duderstadt, K. n., Spetz, J. n., Hsieh, D. n., Platon, C. n., Chapman, S. A. 2020


    Revenue-generating health care activities, generally accepted as a measure of productivity, do not account for the full range of health care activities that enhance patient care.We analyzed the quantity, duration, and type of "service value activities" performed by nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs), which are nonbillable service activities that contribute to billable service provision, quality of care, and value of care.Data were obtained from ambulatory specialties at one health care institution over a 13-month period. First, descriptive statistics were calculated by time-based code for each category of provider (medical, surgical, transplant, hematology/oncology, and anesthesia). Then qualitative comments were analyzed for frequency of key words.Each provider spent an estimated average of between 3.7 and 36.5 hours per month on service value activities, with the greatest number of these activities related to orders, chart review, and documentation.More thorough exploration of the quantity and type of service value activities performed may lead to a better understanding of the role and contribution of NPs, PAs, CNSs, and other health care professionals to patient care.

    View details for DOI 10.1097/JXX.0000000000000439

    View details for PubMedID 32618735