Cross training of APPs on inpatient oncology units as a safe and cost-effective model.

Abstract

56 Background: Oncology Advanced Practice Providers (APPs) have not been optimally trained to care for each other’s sub specialty of patients. In times of high census and/or short staffing, inpatient APPs are left to care for and manage high volumes of acutely ill patients. This is concerning for patient safety, burning out as well as dissatisfactions when vacation and meetings are denied because there is no backup coverage available. Methods: In order to minimize the use of overtime pay, physician moonlighting pay and additional positions in times of short staffing, we proposed to cross train experienced APPs to see if the staffing needs could be met. The disease groups consisted of transplant, leukemia and lymphoma. Each disease group has a lead APP involved in the strategic planning and implementation process. They were instrumental in working through and identifying risks and benefits of this training plan and were the first to be trained, as to lead by example. Buy in from APPs was achieved by promoting the flexibility of scheduling that would result from having more coverage. Some were also motivated to add to their skill set by learning how to care for a new disease group. Results: The APPs felt comfortable taking patients after around 2 training shifts. They felt the patients were more alike than different and the workflow for most job duties were identical, and enjoyed working with fellow oncology APPs they hadn’t interacted much with. Cross training was proposed to add a financial benefit to our institution. Key metrics we monitored were productivity and supplemental pay. The financial savings from avoiding supplemental overtime or fellow moonlighting wages for 2018 was $8,540, and $14,640 for quarter1 2019. The APPs had no decrease in productivity to date, and no decrease in quality metrics and no adverse events related. Conclusions: Cross training as a means to reduce short staffing financial burdens while advancing the scope of practice of APPs is a safe and possible alternative to adding positions, or paying overtime/moonlighting pay. Training of cross covering APPs was not overall a major constraint. Buy-in from leadership as well as APPs is instrumental in not only initiating a cross training program, but maintaining it as well.