Advanced Practice Providers Research Articles

P0705 Features of optimal disease control in Crohn’s disease and Ulcerative Colitis: Views on IBD Expectations and Well-being by Patients and Treatment providers

Abstract Background With the expanding array of therapeutic options for Crohn’s disease (CD) and ulcerative colitis (UC), there is an increasing need to examine features of optimal disease control that reflect patient priorities. Views on IBD Expectations and Well-being - Patients and Treatment providers (VIEW-PT): an analysis based on the IBD Disease Specific Programme (DSP)™, aimed to identify features of optimal disease control in CD and UC, with inclusion of patient and healthcare professional (HCP) perspectives. Methods An iterative 3-Stage approach was used to identify features of optimal disease control in CD and UC (Table 1). In Stage 1, features of optimal disease control were identified by gastroenterologist (GI) advisors, a targeted literature search, and exploratory analyses of the Adelphi Real World IBD DSP. In Stage 2, features from Stage 1 were prioritized by patient advisors and additional features recommended for inclusion. In Stage 3, GI and advanced practice provider (APP) advisors provided further input on relevance of the expanded list of features, terminology, and categorisation. Features mentioned unprompted by patient, GI or APP advisors were cross-referenced to earlier stages and included if identified by ≥4 sources (see details in Table 1). GI and APP advisors provided feedback on similarities and differences of features of optimal disease control for CD vs UC. Results In Stage 1, nine features were identified as most relevant in defining optimal disease control in CD and UC: bleeding, bowel movement frequency, bowel urgency, endoscopic healing, fatigue, pain, quality of life, sleep disturbance, and steroid use. Faecal incontinence and mental health were added in Stage 2 following patient input. GI and APP advisors confirmed relevance of the 11 features in Stage 3; extraintestinal manifestations and biomarkers were added based on advisor recommendation and recurrence at earlier stages. Terminology was finalised and features ordered based on advisors’ recommendations, categorised as symptoms, functional outcomes, or markers of inflammation (Figure 1). GI and APP advisors advocated to include the same features for CD and UC, acknowledging expected variation in prioritisation by indication and across individual patients. Conclusion By considering a range of sources and including patient perspectives, optimal disease control in CD and UC was found to be a multi-faceted concept, incorporating symptoms, functional outcomes, and markers of inflammation. Patient advisors highlighted the importance of faecal incontinence and mental health, which may be overlooked in clinical practice. This robust framework of optimal disease control can be adopted to aid with development of individual IBD management plans in clinical practice.

Clarification and development of advanced practice roles in a Swiss French university hospital: an action research study

BackgroundThe evolving healthcare landscape emphasizes the need for health systems to adapt to growing complexities, with new models of care enabling healthcare providers to optimize their scope of practice and coordination of care. Despite increasing interest in advanced practice, confusion persists regarding the roles and scopes of practice of healthcare providers, exacerbated by variations in regulations and titles. We sought to clarify the differences between specialized healthcare professionals, practitioners, and clinical specialists; to describe their roles; and to propose initiatives aimed at supporting the implementation of advanced practice within a university hospital.MethodsAn action research design was conducted in a Swiss university hospital by the deputy healthcare director, five clinical specialists, one nurse practitioner, one nurse specialist, and six managers. A multimethod approach was used to generate data, which included a literature review, meeting minutes, unstructured interviews, and a questionnaire assessing healthcare providers’ perceptions about the clinical specialist role. Semi-structured interviews and a group interview with nursing leaders from Swiss hospitals were conducted to understand their use of clinical roles at the advanced level. Unstructured interviews were reduced and organized into categories. Survey data were analyzed with descriptive statistics, and an inductive content analysis method was used for semi-structured interviews and the group interview.ResultsManagers and healthcare providers shared a vision of clinical specialists’ activities but emphasized the lack of clarity surrounding these functions. Role clarity was emphasized as crucial for sustainability of advanced practice. A model that defined healthcare specialist, practitioner, and clinical specialist roles was developed. It included title standardization, use of an implementation strategy, creation of a tool to facilitate profile selection, and implementation of a communication plan. Further initiatives aimed to enhance training funding, establish regulations, and optimize advanced practice implementation and governance within the hospital.ConclusionsThe study results encourage clarification of clinical roles to facilitate their implementation and optimize resources. They also suggest initiatives to support advanced practice implementation, such as a communication plan and an implementation strategy, reflection on the current governance model, and integration of advanced practice providers. Ongoing efforts involve collaboration with academics, managers, and discussions at the political level.

Stressors contributing to burnout among acute care and trauma surgery care teams: a systems-analysis approach

BackgroundBurnout negatively impacts healthcare professionals’ well-being, leading to an increased risk of human errors and patient harm. There are limited assessments of burnout and associated stressors among acute care and...

The Impact of COVID-19 on the Division of Household Labor Among Women Physicians and Advanced Practice Providers.

COVID-19 increased the burden of childcare on parents, leaving women vulnerable to increased disparities in the division of domestic labor. Women healthcare workers may be at heightened risk of worsening gender parity in the workplace as a result. To examine the impact of the COVID-19 pandemic on gender parity in the division of household responsibilities among women healthcare workers. Cross-sectional survey assessing changes in the workplace and changes in the balance of domestic duties with partners via multiple open-ended and Likert-scale type questions. Data were analyzed descriptively, including thematic analysis of free-text responses. This survey study included 1459 women healthcare workers and 244 of their partners. Primary outcomes were levels of responsibility for domestic labor, including housework, childcare, and child education. Free-text questions focused on the impact of household responsibilities on the workplace. In total, 1459 healthcare workers identifying as women responded to this survey. Of them, 655 (45%) practice in an academic setting, and 1025 (70%) are physicians. Additionally, 244 self-identifying partners of women healthcare workers responded; the majority were men (204 [84%]), and over one-third (91 [38%]) work in healthcare. Among respondents overall, women reported doing most of the housework (52% of respondents [756/1459] versus 27% of partners [61/244]) and child education, compared with their partners (31% of respondents [451/1459] versus 23% of partners [55/244]). Thematic analysis of free-text questions revealed that women experienced worsened gender parity in the workplace because of increased household responsibilities. We observed significant gender-based disparities in the division of household labor among healthcare workers, with negative impacts on work performance, focus, and academic productivity. Our results support the notion that the COVID-19 pandemic worsened gender parity in the homes of healthcare workers, thus negatively affecting gender parity in the medical workplace.

Iowa emergency departments lack board-certified emergency physicians: A comprehensive statewide emergency department workforce study.

The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states. An electronic and telephone survey of nonfederal Iowa EDs was conducted using a structured data collection instrument. Responses were collected from a leadership representative at each facility (medical director or nurse manager). The data collection included both objective staffing data and Likert-style questions about reasons for staffing and operational practices. We obtained hospital characteristics from the American Hospital Association and directly compared these results to a similar Iowa study conducted in 2013. Summary data were presented as counts and percentages, and physician staffing was compared between critical-access hospitals (CAHs) and non-CAHs. CAHs represent a type of rural hospital in the rural setting. Responses from 113 of 116 (97%) Iowa EDs were recorded. Of responding EDs, 19 (17%) were staffed exclusively by EM residency-trained and/or EM board-certified physicians (EPs), 72 (66%) were staffed by a combination of EPs and non-EPs (physicians who completed a residency other than EM), 19 (17%) were staffed exclusively by non-EPs, and 52 (46%) were staffed either fully or at times by advanced practice providers (APPs) without in-house supervision. In the subgroup of CAHs, only three (4%) staff only EPs, compared with 16 (42%) of non-CAHs (difference 38%, 95% confidence interval [CI] 24.6%-51.2%). Providers staffing CAHs were more likely than those at non-CAHs (88% vs. 63%, difference 25%, 95% confidence interval [CI] 9.5%-40.2%) to have responsibilities outside the ED, the most common being inpatient cardiac arrest management (n = 84, 74%). The most common reason for hiring EPs was the quality of care they provide (n = 47, 58%), and the most common reason for hiring non-EPs was low availability of EPs (n = 56, 70%). Compared to the 2013 Iowa ED workforce study, the proportion staffed by EPs only were similar (increased by 5.5%, 95% CI -14.7% to 3.7%) and by non-EPs only was similar (decreased by 10.5%, 95% CI -0.4% to 21.3%). EDs staffed solely by APPs decreased from decreased by 13.2% (95% CI 0.3%-26.2%) to 47% in 2023. Iowa EDs are predominantly staffed by non-EPs, and this remains unchanged despite a decade of increasing EM residency positions nationally. There remains a significant disparity between CAHs and non-CAHs. This study demonstrates that EM residency position increases have not penetrated rural Iowa EDs, where there remains both a substantial shortage and desire for EP staffing.

Utilization of Telemedicine for Patients Receiving In-center Hemodialysis in the United States.

In March 2020, responding to the COVID-19 pandemic, federal emergency waivers in the United States enabled kidney care providers (nephrologists and advanced practice providers) to substitute face-to-face in-center hemodialysis visits with telemedicine encounters. We examined whether the frequency of kidney care provider visits and hospitalizations were associated with telemedicine use in hemodialysis care. We used Medicare claims to identify US patients receiving in-center hemodialysis during the first 16 months of the COVID-19 pandemic. We examined the association between telemedicine use during in-center hemodialysis, the frequency with which kidney care providers visited patients at dialysis four-or-more times per month, and hospitalizations. We also examined whether the association between telemedicine use and visit frequency varied at facilities located in more remote areas. Multivariable regression models adjusted for patient, physician, geographic and dialysis facility characteristics along with the frequency with which kidney care providers saw patients at each facility before the pandemic. We focused on kidney care providers who demonstrated knowledge of how to bill for telemedicine visits by using the telemedicine modifier on prior claims. We identified 1,881 providers who saw patients between 3/2020-6/2021 and were definitively using telemedicine. In the adjusted model, a 35% absolute higher use of telemedicine at a facility (representing one standard deviation difference) was associated with a 1.4% higher rate of four-or-more visits (Incidence Rate Ratio (IRR) 1.014; 95% Confidence Interval 1.007-1.022). The association between telemedicine use and visit frequency was stronger where travel distances to facilities were farther (interaction p=0.01). There was no significant association between telemedicine use and hospitalizations. The use of telemedicine to care for patients receiving in-center hemodialysis was associated with a slightly higher frequency of four-or-more visits per month but not with hospitalizations; the association with visit frequency was more pronounced in areas where providers had to travel longer distances to see patients in-person.

Patients with DCIS Seen at a Specialized High-Risk Breast Clinic Run by Surgical Advanced Practice Providers Have High Rates of Preventive Medication Uptake.

Preventative medication (PM) uptake is low among patients at an elevated risk of breast cancer, largely due to fears of intolerance. This study aimed to investigate whether a new, surgical advanced practice provider (APP)-run clinic was effectively prescribing PM. We hypothesized equivalent rates of PM uptake compared to consultation with medical oncologists (MD). The APP-run clinic and accompanying database were initiated 01/2023, including patients with benign breast complaints and/or an elevated risk of invasive breast cancer. A historic single-institution surgical database and this prospective database were queried for patients with ductal carcinoma in situ between 04/2007-05/2023 and 01/2023-01/2024, respectively. Patients with invasive breast cancer within the prior 5years were excluded. Chart review abstracted PM type/dose. Chi square analysis compared PM uptake rates and dose. A total of 523 patients met study criteria; the MD sample and APP sample were relatively well balanced except fewer hormone receptor positive patients in the MD sample (266/309 [86.1%] versus 202/214 [94.4%] APP, p < 0.01). PM uptake was lower in the MD sample (96/309 [31.1%] compared to the APP sample (86/214 [40.2%], p = 0.03). There was significantly more tamoxifen prescribed among the APP sample (58.2% vs. 35.6% among MD, p = 0.02), and low-dose tamoxifen prescribing increased significantly (47.3% vs. 9.8% MD, p < 0.01). Our surgical APP-run breast health clinic has demonstrated equivalent PM uptake as compared to patients seen previously by medical oncologists. This model should be considered broadly. Additionally, low-dose tamoxifen has become the prescription of choice; thus, long-term studies of tamoxifen 5 mg are warranted.

Economic impact of reduced postoperative visits after inflatable penile prosthesis implantation.

Aim: This study assessed the economic impact of reducing one postoperative visit following inflatable penile prosthesis (IPP) implantation. Methods: Scenario analyses were used to model the effects of eliminating one 30-min IPP postoperative visit from the expected 2.5 visits accounted for by the American Medical Association resource-based relative value scale data. The reduction was attributed to simplified teaching with a modified device. The recaptured time was applied to: the most frequent in-office CPT codes utilized by IPP implanters; evaluation and management of new ED patients pursuing/receiving IPPs; and in-office vasectomy. Physician work time and reimbursement were conservatively estimated using the 2024 Medicare Physician Fee Schedule and an alternative scenario where Advanced Practice Providers conducted IPP teaching was also modeled. Results: Annually, reducing one 30-min IPP postoperative visit for practices performing 25/50/100 IPP implants recaptured 750/1500/3000min, respectively. This recaptured time translates into as much as $18,325 additional annual Medicare reimbursement. At 25 implants yearly, urologists could help an additional 13-25 patients with office visits and observe an additional $2049-$2270 reimbursement. At 50 implants yearly, office evaluation and counseling for 7 ED patients who progress to IPP implantation results in an additional $4125 reimbursement, excluding any diagnostic procedures and/or downstream surgical cases. At 100 implants yearly, recaptured schedule capacity can facilitate 37 in-office vasectomies, which translates to a $12,563 reimbursement. Conclusion: Achieving fewer IPP postoperative visits can optimize postoperative care and open schedule capacity that improves access to care for patients with urological needs.

Adding Insult to Injury: The Impact of Musculoskeletal Pain on Fishermen’s Sleep Patterns

ABSTRACT Objectives Commercial fishing is one of the most dangerous industries in the United States, and although injuries have been a prominent focus for research, some health and safety risk factors such as sleep are understudied. In this paper, data from a multi-modal research study of sleep patterns, lifestyle factors, occupational exposures, medical histories, and health assessments in four U.S. fisheries are used to explore the connections between pain and sleep. Methods A mixture of randomized cluster sampling, study promotions, and dockside recruitment was utilized to gather a sufficient number of fishermen in the Alaska Salmon, Oregon Dungeness Crab, Massachusetts Scallop, and Massachusetts Lobster fisheries for the study. Fishermen were surveyed about sleep patterns, occupational exposures, and lifestyle factors. Surveyed fishermen were provided with free comprehensive health assessments by occupational health nurses and physicians or Advanced Practice Providers. Data were collected in REDCap and downloaded into SAS for analysis using a variety of analytic methods. Results A total of 262 surveys and 162 physical examinations were completed with captains and crew members in the four fisheries targeted for study. The average self-reported consecutive hours of sleep for fisheries workers that spend several days at sea (i.e. Crab, Scallop, and Salmon fisheries) were roughly 3.5 to 4.0 h in a 24-h period. Of particular note, the majority of fishermen, regardless of fishery, suffered from back pain, and roughly 40% of fishermen noted pain and discomfort significantly impede their ability to sleep. Conclusions This study underscores the connections between musculoskeletal pain and sleep, providing yet further impetus for preventing musculoskeletal injuries among fishermen. Given the ties between existing sleep debt in the industry and the health and safety risks posed by repeated exposure to insufficient sleep, this study highlights the need for the prevention of these injuries and potentially better treatment options for fishermen who suffer from musculoskeletal disorders.

Advanced Practice Provider (APP) Residency Program to Strengthen the Kidney Health Workforce.

Advanced Practice Provider (APP) Residency Program to Strengthen the Kidney Health Workforce.

Measuring the Impact of Healthcare Provider Availability on Quality of Care and Disease Burden in Ohio: A Cross-Sectional Study.

Chronic lower respiratory disease, heart disease, and diabetes have a higher prevalence in rural areas. Previous studies raise concerns that a lower supply of physicians is associated with negative outcomes. To assess disease burden across the 88 counties in Ohio, including Appalachian and non-Appalachian counties, and examine associations with the number of healthcare providers. We utilized data sourced from the Centers for Medicare & Medicaid Services (CMS) and the Mapping Medicare Disparities tool. We conducted ANOVA to compare the mean number of primary care physicians (PCP), specialty physicians, advanced practice providers (APP), and other healthcare providers for Ohio counties. We calculated mean prevalence, principal cost, and prevention quality indicator (PQI) by health condition. We analyzed the relationship between healthcare providers and the PQI across counties, and examined differences in healthcare providers and disease burden between Appalachian and non-Appalachian regions. The mean number of providers per 100,000 people significantly differed between PCP, specialty physicians, APP, and other healthcare providers (F = 13.9, P < 0.001). The prevalence of hypertension (mean = 67.0, SD = 2.2) and diabetes (mean = 27.1, SD = 2.4) was the highest of the selected conditions. The number of preventable hospitalizations from chronic conditions (mean = 2024.9, SD = 526.8) was significantly higher (P < 0.001) than the number of preventable hospitalizations from acute conditions (mean = 851.6, SD = 262.2). The multivariate mixed effects model of PCP*Specialist*APP*Other was the best predictive model for all health conditions (P < 0.001). COPD (mean = 17.4, SD = 2.8) and diabetes (mean = 28.4, SD = 2.3) in Appalachian counties were significantly higher (P < 0.001) than COPD (mean = 13.7, SD = 1.9) and diabetes (mean = 26.2, SD = 2.1) in non-Appalachian counties. This study found higher PQI scores for chronic conditions than acute conditions, indicating the need for higher-quality outpatient care to prevent avoidable hospital admissions. Further, Appalachian counties had fewer other healthcare providers and many counties lacked specialist physicians, highlighting significant disparities in healthcare access in Appalachian Ohio.

An Explanatory Mixed-methods Study of "ICU net benefit": Triage and Trajectory for Sepsis and Acute Respiratory Failure.

Patients with sepsis and/or acute respiratory failure are at high risk for death or long hospital stays, yet limited evidence exists to guide triage to intensive care units (ICUs) or general medical wards for the majority of these patients who do not initially require life support. To identify factors that influence how hospitals triage patients with capacity-sensitive conditions and those factors that may account for observed ICU relative to ward, or ward relative to ICU, benefits for such patients. We conducted an explanatory sequential mixed-methods study. As part of a 27-hospital, two-health system retrospective cohort study, we calculated hospital-specific measurements of ICU net benefit for patients with sepsis and/or acute respiratory failure. Hospitals among the highest ICU net benefit and lowest ICU net benefit (or highest ward net benefit) from each study health system were selected for in-depth qualitative study. At each hospital interviews were conducted with emergency department (ED), ward, and ICU clinicians and administrators. Interview transcripts were analyzed using flexible coding and the framework method. Interviews were conducted with 118 respondents (46 physicians, 43 nurses, 5 advanced practice providers, and 24 administrators) from four hospitals. Respondents across hospitals agreed that the prediction of patient trajectory is central to triage decisions, but there was variation in opinion across work locations about optimal pre-triage ED interventions in terms of intensity, repetition, clinical reassessment, and observation duration. The main difference observed between high and low ICU net benefit hospitals related to the way respondents working in the ICU and ward described their responses to patients who experience rapid clinical deviations from triage-expected trajectories including sustained lack of critical care needs after admission to the ICU and acute critical care needs after admission to the ward. Hospitals with low ICU net benefit (or high ward net benefit) had particularly robust and proactive rapid response and clinical decompensation surveillance practices for ward-admitted patients. Particularly proactive rapid response programs that deliver on-location critical care may quantitatively increase ward net benefit by bringing ICU benefits without ICU-associated harms to ward patients who become critically ill.

Diabetes medication prescribing trends based on provider type and location in the United States.

As primary care physician numbers continue to decline, more patients with type 2 diabetes are likely to receive care from advanced practice providers (APPs), including physician assistants and nurse practitioners. Analyzing diabetes medication prescribing trends among these provider types is essential for ensuring evidence-based diabetes care. Purpose: This retrospective, cross-sectional pilot study aimed to examine differences in type 2 diabetes medication prescribing trends by provider type (physicians vs. APPs) and geographic location, utilizing National Ambulatory Medical Care Survey (NAMCS) data. Data from the NAMCS were collected in August 2022 for the years 2015, 2016, 2018 and analyzed using IBM SPSS, employing chi-square analysis to assess associations between provider type, geographic location, and prescribed medications. Frequency distributions were calculated for patient characteristics and provider types. Patients prescribed at least one diabetes medication (N=1444) were included. Most received care from physicians (93.7%) in metropolitan areas (82.8%). Statistically significant associations were found between provider type, geographical location, and medications prescribed. Nurse practitioners were more likely to prescribe newer diabetes medications, while physician assistants frequently prescribed basal insulin. Patients in non-metropolitan statistical areas were more often prescribed older medications, whereas those in the West were less likely to receive older medications. The study revealed distinct prescribing patterns by provider type and geographic location. Notably, APPs tended to prescribe newer or specific medications in certain locations, highlighting the influence of provider type and geography on diabetes care. Further studies should include larger samples of APPs to deepen insights into these trends.

Evaluating Advance Practice Provider–Driven Initiatives to Reduce Time to Treatment

Patients referred for chronic pain and spasticity management are often prescribed evaluation for intrathecal pump (ITP) placement. The purpose of this study was to determine whether an ITP protocol bundle decreased time from referral to ITP trial. Data were abstracted from an existing database for time from referral to advanced practice provider appointment, pump trial, and pump placement. The mean ± SD time from referral to trial was similar before and after implementation (81.9 ± 60.6 days vs 54.7 ± 36.9 days; P = .084). Although several factors were found to influence outpatient care, this bundle shows the potential to reduce time from ITP referral to ITP placement.

Sustaining a 24/7 Advanced Practice Provider Care Model and the Impact on Quality Metrics

Sustaining a 24/7 Advanced Practice Provider Care Model and the Impact on Quality Metrics

A Dynamic Convergence: ANCC Accreditation. Leading Learning.

The American Nurses Credentialing Center (ANCC) is a globally recognized leader in credentialing and accreditation. Among its cornerstone programs are the ANCC Nursing Continuing Professional Development Accreditation Program, the ANCC Practice Transition Accreditation Program®, and the ANCC Advanced Practice Provider Fellowship AccreditationTM program. The ANCC additionally holds a pivotal role as a founding member in Joint AccreditationTM, an interprofessional continuing education accreditation for health professionals. As health care evolves, the ANCC remains at the forefront, advancing nursing practice, fostering innovation, and providing support and education to stakeholders. [J Contin Educ Nurs. 2025;56(1):5-7.].

Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey.

Physicians-in-training (residents, fellows) and Advanced Practice Providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period. Electronic-mail surveys were sent to physicians-in-training and APPs, in five categories of practice (Anesthesiology, Internal Medicine, Family Medicine, Obstetrics/Gynecology/Gynecologic Oncology, and Surgery) at nine major institutions. Cochran-Mantel-Haenszel (CMH) tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-p-values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from CMH tests. We received 2236/6724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-p<0.001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-p<0.001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-p<0.001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-p<0.001) as Anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in Surgery (48%) and OB/GYN (46%) reported not routinely asking. Differences also existed by physician PGY clinical training (FDR-adjusted-p=0.005) with those with higher PGY reporting they asked about OSA more often. Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.

POSTOPERATIVE DELIRIUM: A SURVEY OF PERCEPTIONS AND KNOWLEDGE AMONG SURGICAL PROVIDERS

Abstract Postoperative delirium is associated with delayed recovery and cognitive decline. Despite increasing awareness among medical providers, understanding of delirium among surgical providers remains unknown. We aimed to evaluate knowledge and confidence in identifying and managing postoperative delirium, and to determine surgeons’ perceptions of the relative importance of postoperative delirium. A 14-question survey was distributed to surgeons and surgical advanced practice providers (APP) after validation through cognitive interviews. Eighty-five of 267 responded (31%), more attending surgeons (67%) than APPs (33%). Most had &amp;gt;5 years of experience (73%). Respondents estimated postoperative delirium rates from 0% to 65%, with the average varying by field from 5% (Endocrine surgery) to 33% (Trauma and Critical Care). Most had received formal delirium training (66%) and felt confident in identifying (80%) and managing (65%) delirium. Postoperative delirium was identified by nursing concerns (89%) or clinical gestalt (82%), with few reporting the use of validated tools (23%). Out of 6 common postoperative complications, surgical providers ranked postoperative delirium 3rd (28%) or 4th (25%), below cardiac complications (78%) and above superficial site infections (53%). The most concerning consequence of delirium was mortality (62%), with few concerned about psychological distress (16%). Most (60%) thought post-operative delirium had a limited effect on long-term health. Despite self-reported knowledge and high confidence in identifying and managing postoperative delirium, objective measures are rarely used, and long-term effects are thought to be minimal. Gaps in knowledge around delirium diagnosis and long-term health effects may contribute to the ongoing burden of delirium in older surgical patients.

Pediatric Intensive Care Provider Attitudes About Children with Medical Complexity and Neurologic Impairment: A Qualitative Study.

(1) Background: Children with medical complexity (CMC) and neurologic impairment (NI) are a growing population in pediatric intensive care units (PICUs). (2) Objective: Our aim was to explore and describe the experiences and beliefs of PICU providers caring for CMC with NI. (3) Methods: A qualitative interview-based study was conducted. Participants were 20 providers (12 attendings and 8 nurse practitioners) who met inclusion criteria of being a faculty, fellow, or advanced practice provider who worked in a PICU; residents were excluded. Participants were recruited via purposive and snowball sampling until information power was reached, and came from seven PICUs across six states, with 10 participants from the authors' home institution and 10 from external PICUs. Data were collected via recorded videoconference interviews, which were transcribed. Analysis was conducted and relevant themes were identified using the analytic technique of thematic analysis. Rigor was assured by using two coders. (4) Results: Four main themes were identified: (i) providers view CMC with NI as a distinct population of growing importance; (ii) CMC with NI have care needs that challenge traditional perceptions of PICU practice; (iii) PICU providers expressed ambivalence towards caring for CMC with NI; and (iv) some PICU providers have developed adaptive strategies. (5) Conclusions: This population challenges the typical notion of what pediatric critical care represents. Providers display ambivalence about caring for these patients but can develop strategies to make this work meaningful. Understanding PICU clinicians' views about CMC with NI can provide insights for improved patient care and reduced provider burnout as the field adapts to this population.

Examining Shift Length and Fatigue: A National Study of Neonatal Advanced Practice Providers.

Neonatal advanced practice providers (APPs) often work prolonged hours in high-acuity neonatal intensive care units (NICUs). It is imperative to understand how fatigue affects the APP's ability to react quickly following long shifts. There is a lack of data on the effects of shift length and fatigue on neonatal APP job performance and clinical decision-making. The purpose of this study was to describe the variation in shift length, knowledge-based competency, personal well-being, and behavioral alertness for neonatal APPs. This study evaluated neonatal APPs before and after a clinical shift. Provider well-being was assessed during the pre-survey. Pretest-posttest surveys evaluated neonatal APP's psychomotor vigilance skills and knowledge. Participants completed an online, anonymous questionnaire to answer a series of knowledge-based questions before and after their shift, along with a psychomotor vigilance test (PVT). A paired t test analysis evaluated the pre- and post-shift PVT values and knowledge-based test scores. Overall, 61 pre-surveys and 42 post-surveys were completed; 36 were matched by participants pre- to post-survey. The mean between pre- and post-knowledge-based questions was statistically significant, with higher posttest scores. There was no statistical difference noted in the paired t test analysis of the PVT values. The small sample size may limit the generalizability of findings, but these results may indicate that shift length does not affect psychomotor vigilance or knowledge-based competency. It is vital that future work assess the associations between APP shift length, fatigue, and critical decision-making.