107: CURRENT LANDSCAPE OF ADVANCED PRACTICE PROVIDERS IN CRITICAL CARE

Abstract

Introduction: Advanced Practice Providers (APPs) are a well-established part of the multidisciplinary critical care team, but the scope and utilization of APPs vary dramatically between hospitals. This survey captures current demographic, workflow, and utilization trends in the Society of Critical Care (SCCM) APP community. Methods: This was a cross sectional REDCap survey emailed to 2775 SCCM physician assistant or nurse practitioner members in April 2021. There were 578 responses (20.8%) with 60 non-APP respondents excluded for a sample size of 518. Statistical analysis was performed via SPSS. Results: Of the 518 respondents, there were 149 (28.8%) physician assistants and 327 (63.1%) nurse practitioners. Most respondents (n=371, 72%) were female. 248 APPs (48.1%) worked for large hospitals (>500 beds) and most (n=343, 66.2%) worked in an academic setting. Of the surveyed, 447 (86.3%) reported greater than 2 years of ICU experience. Formal onboarding was common (n=354, 68.6%) and was most likely to occur in academic medical centers (n=233 of 354, p< 0.001). Onboarding was usually completed in under 6 months (n=310, 87.8%). Most APPs (n=409, 79.3%) did not pursue post-graduate fellowships. Most units had full time APP coverage (n=361, 70.1%) including weekends and holidays (n=427, 82.8%). Daytime APP to patient ratios were less than 1:10 (n=377, 75.7%); nighttime ratios were 1:11 or greater (n=328, 72.9%). The majority of APPs performed arterial lines (n=425, 82%), central venous catheters (n=410, 79.2%), temporary dialysis catheters (n=318, 62.4%), and point-of-care ultrasound (n=295, 56.9%). APPs most frequently billed critical care time (n=314, 60.6%) and procedures (n 333, 64.3%). A quarter of respondents (n=137, 26.4%) reported that they did not bill. APPs did not routinely have their billing measured (n=212, 41.5%) and many (n=106, 20.7%) did not know if productivity measures were utilized in their group. Conclusions: APPs are experienced members of the critical care team heavily utilized in large academic hospitals. Current APP roles are mostly clinical and unit-based, with emphasis on procedures and episodic care. Additional research will better quantify APP productivity and value since metrics are inconsistent and many APPs do not currently participate in billing.