A care delivery model for hepatopancreatobiliary patients utilizing advanced practice providers

Abstract

Objective: Present an inpatient care delivery model utilizing advanced practice providers (APP) on the Hepatopancreatobiliary (HPB) service at Memorial Sloan Kettering Cancer Center. Methods: The role and efficacy of APPs in managing patients in acute care settings has been well described and established in publications dating back to 2005. HPB is a specialty surgical practice that requires APP's to have advanced understanding of the HPB disease processes, critical care principles, and general surgery principles. It also requires the APP to have advanced competencies for radiology, gastroenterology and interventional radiology. The APP surgeon relationship is integral to the success of the model, as is maintaining open communication within the surgical team, with nursing staff and with the multidisciplinary team. Results: The APP provides direct patient care from admission through discharge, ensuring continuity. The APP is paired with one or two surgeons, fellows and a resident. The APP functions with a high level of independence and makes important decisions while maintaining open communication within and between teams to achieve optimal patient throughput. The APP is the primary contact for staff nurses, consults, and other multidisciplinary services while the HPB teams (surgeon, fellow and resident) are in the operating room, clinic or attending to academic responsibility. The APP facilitates complex discharges with case management and ensures timely and smooth transitions of care. Conclusion: APP's provide high level, patient centered care, to the multifaceted complex HPB patient. The development of future HPB APPs requires specialty training, and perhaps an HPB APP fellowship.