Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care.

BACKGROUND: Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models. OBJECTIVES: We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs. RESEARCH DESIGN: Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes. MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay. RESULTS: The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay. CONCLUSIONS: Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.

Pediatric nurse practitioner's perceived organizational support in academic and nonacademic institutions.

BACKGROUND: The role of the pediatric nurse practitioner (PNP) has changed since its inception over 50 years ago. Pediatric nurse practitioner practice has evolved from providing outpatient primary care to children to providing complex care in the acute practice environment. PURPOSE: The purpose of this study was to describe whether a difference existed in perceptions of organizational support (POS) of PNPs working in academic and nonacademic institutions and to describe the differences between PNP reporting structures and POS. METHODS: A quantitative cross-sectional design was used with a convenience sample (n = 86) of PNPs from the membership list of the Pediatric Nurse Credentialing Board (PNCB). A formal written request was sent to the PNCB to access their membership after which institutional review board approval was obtained from Case Western Reserve University. Participants received an online cover letter with links to the surveys to be completed. The PNPs were asked to complete a demographic/institution characteristic survey and Eisenberger Perceived Organizational Support Survey (POS). RESULTS: More than 63% of the PNPs participating in this national survey, practicing in both academic and nonacademic affiliated hospitals, had positive perceptions of organizational support. No differences were found between the academic and the nonacademic affiliations. IMPLICATIONS FOR PRACTICE: Because PNPs are integral to the provision of care to children, providing opportunities for PNPs to continue to enhance their clinical skills and practice to the full extent of their scope of practice will only enhance their perceptions of organizational support. This dynamic creates a win-win for the PNP, the institution, the patients they care for, and the US health care system.

The accuracy of paediatric limb radiograph interpretation by nurse practitioners in a single centre.

BACKGROUND: Nurse practitioners (NP) are an integral part of the urgent and emergency care workforce in the United Kingdom providing safe and effective care. Despite this, there is limited research assessing the ability of NPs to correctly interpret isolated paediatric limb injury radiographs in the urgent and emergency care environment. AIM: The aim of this study was to compare the accuracy in interpreting isolated paediatric limb radiographs between NPs and consultant radiologists. SETTING: A nurse-led urgent care centre (UCC) in central London, United Kingdom. PARTICIPANTS: 296 paediatric patients with isolated limb injuries who had a radiograph requested and interpreted by an NP. METHODS: Thirteen NPs (adult registered) with various backgrounds and qualifications participated in this prospective, single-centre healthcare analysis. Review of all clinical presentations at the UCC over a 3-month period (September-November 2017) identified 296 paediatric patients (aged 2-15) who received a peripheral limb radiograph. Clinical records for each patient were analysed to document demographics, mechanism of injury, NP examination findings, radiographic interpretation and formal radiologist report. NP interpretation of each radiograph was classified as definite fracture, possible fracture or no fracture. This was compared to the final radiologist report (considered the gold standard) to calculate the sensitivity and specificity of NP radiograph interpretation. RESULTS: NPs reported a total of 94 radiographs (32%) as definite fracture, 176 (59%) as no fracture and 26 (9%) as possible fracture, as compared to radiologists at 71 (24%), 218 (74%) and 7 (2%). A total of 242 (82%) of radiographs were correctly identified by NPs, while 54 (18%) were incorrectly interpreted. The sensitivity of the NP limb radiographic interpretation was 92%, with a specificity of 78%. CONCLUSIONS: The findings validate the clinical and diagnostic skills of NPs in the interpretation of isolated paediatric limb radiographs.

Using Google to Survey PNPs About Agricultural Safety.

INTRODUCTION: Youth and children in agriculture are highly vulnerable to the health hazards associated with agricultural work and the rural environment. METHODS: The purpose of this study was to conduct a national needs assessment for developing a continuing education unit that increases the knowledge of pediatric nurse practitioners (PNPs) on safety in an agricultural environment using the Google family of products. This was a cross-sectional, one-group design descriptive-correlational study. RESULTS: Surveys were received from 315 participants. On Day 1, 57% of responses were received, and 91% were received within Week 1. DISCUSSION: The use of the free Google Forms and Google Sheets facilitated this researcher to obtain a sample size, saving research expense dollars, and entering data file into SPSS. In addition, a pattern of survey return rates was demonstrated. Second, clinical implications indicate that agricultural safety is missing from PNP curricula: PNPs are not knowledgeable about existing resources and would be interested in a continuing education unit.

Management of natural health products in pediatrics: a provider-focused quality improvement project.

INTRODUCTION: The use of natural health products by pediatric patients is common, yet health care providers often do not provide management guidance. The purpose of this project was to improve management of natural health products by pediatric nurse practitioners. METHOD: Pediatric nurse practitioners from large metropolitan city were recruited (n = 32). A paired pretest-posttest design was used. Study participants were engaged to improve knowledge of natural health products, and a management toolkit was created and tested. RESULTS: Mean knowledge scores increased from 59.19 to 76.3 (p < .01). Management practices improved with regard to patient guidance (p < .01) and resource utilization (p < .01). Assessments of product use (p = .51) and drug/herb interactions (p = .35) were not significant. DISCUSSION: This investigation is the first known study to improve knowledge and management of natural health products in pediatric clinical practice.

Paediatric ED reattendance rates: comparing nurse practitioners and other clinicians.

OBJECTIVE: The aim of this project is to establish the unplanned reattendance rate for paediatric emergency nurse practitioners (PENPs) working in a designated paediatric emergency department (PED) while identifying the case mix of patients seen by PENPs compared with their medical counterparts. DESIGN: Quantitative data regarding patient characteristics and reattendance were collected during retrospective review of case notes across two representative 2-week periods. SETTING: The study site is a tertiary urban PED with an annual attendance of 32 000 patients aged from birth to 15 years. MAIN OUTCOME MEASURES: Reattendance rates, patient characteristics, triage scores, presenting complaint and numbers of patients discussed with a paediatric emergency medicine consultant were evaluated. RESULTS: The results showed that PENPs have a lower reattendance rate (1.75%) when compared with senior and junior doctors in training (4.29%, 5.76%); however, PENPs treat a different population of children. When the odds of PENP reattendance are adjusted for this, the significance of the difference becomes less certain. CONCLUSIONS: PENPs work autonomously when seeing children presenting with minor trauma and make a positive contribution in achieving the reattendance Clinical Quality Indicator.