Professional Practice Evaluation

Enhancing Patient Safety and Quality Through Advanced Practice Professional Training Initiatives

By DeLaine Christie, CPCS, CPMSM

Last fall, I had the distinct honor of presenting at the NAMSS 2024 conference in Denver. My objective was to share with medical services professionals the comprehensive process Health First implemented for training advanced practice professionals (APPs). The session attracted approximately 100 attendees, and I received invaluable feedback highlighting the widespread challenges organizations face due to the insufficient training of APPs entering the acute care setting. My goal is to now disseminate this information more broadly in the event others may find our approach equally beneficial.

The Why

The healthcare landscape is evolving rapidly, with an increasing number of APPs playing pivotal roles in patient care. This training plan aims to address the growing presence of APPs and the potential impact on patient safety and quality. By focusing on comprehensive training processes, preceptorship opportunities, and bridging knowledge gaps, this plan seeks to enhance the capabilities and competencies of APPs, ensuring that they are well equipped to deliver safe and effective care in the inpatient setting.

The rise in the number of APPs, including nurse practitioners, physician assistants, and clinical nurse specialists, has been significant in recent years. This growth is driven by the need to address physician shortages, improve access to care, and positively enhance patient outcomes. However, the rapid integration of APPs into healthcare teams necessitates robust training and support systems to ensure that patient safety and quality of care are not compromised.

Safe and Effective Training Processes

A cornerstone of this initiative is the implementation of safe and effective training processes for APPs. This involves the creation of structured plans that cover essential clinical skills, patient management, and evidence-based practices by specialty. We determined that the training programs we were to develop would need to be tailored to the specific needs of APPs, considering their varied backgrounds, levels of experience, and competency. The ask from the Credential Committees at Health First was to develop specialty specific train up plans that included didactic training, a list of common diagnoses for each specialty and specific bedside procedures that the APP’s would need to be privileged for.

We created a two-phased plan. Phase one included the didactic training and precepting. Phase two followed the process we already had in place for initial application-focused professional practice evaluation (FPPE), which consists of proctoring and chart reviews. At Health First, we identified 23 APP specialties that needed the development of a train-up plan. We formed an APP subcommittee with eight APP members ranging in specialty, training, and employment. The subcommittee also had three physician leaders: two credential committee chairs and a chief medical officer (CMO). This small and mighty subcommittee successfully created and implemented 23 specialty specific train-up plans. As needed, we would involve the department chairman and/or section chairman for input on their specific specialty. 

Preceptorship Opportunities

Preceptorship plays a vital role in the professional development of APPs. Experienced clinicians serve as mentors, providing guidance, support, and real-time feedback. This hands-on approach helps our APPs transition smoothly into clinical practice in the acute care hospital setting.

The train-up plans include proctoring/precepting for specific specialties, diagnoses, and procedures, and are set up for the APP providers to receive constructive feedback in real time. This helps foster a supportive learning environment and reassurance that the APPs are able to develop the necessary skills and confidence needed to deliver high-quality, safe patient care.

Bridging the Knowledge and Skills Gap

To bridge the gap in knowledge and skills, our train-up plan process includes:

• Needs Assessment: Conducting thorough assessments to identify specific areas where APPs require additional training and support. The APP multi-specialty committee (created by our medical staff leadership) includes participants with different levels of experience and educational backgrounds and a few physician champions to assist with the process.
• Customized Training Modules: The subcommittee was asked to develop tailored training plans that would address gaps in knowledge and focus on critical areas such as patient safety, clinical decision-making, and interprofessional collaboration. This included didactic training and specific clinical training.
• Continuous Evaluation: Continuous evaluation mechanisms to monitor the progress of APPs and make necessary adjustments to training programs have been implemented

Equipping APPs for Success

Since Health First went live in June 2024 with this program, we have implemented train-up plans to 30 APPs of varying specialties. Through monitoring and collaboration, we were able to identify an issue with a sub-specialized APP for breast surgery because we initially developed a plan for only general surgery. This plan didn’t accommodate much of what this APP would be doing, so we worked with the supervising physician to create a more specialized plan. We can proudly say post-implementation we have had zero patient safety portals involving newly onboarded/trained APP providers. We are continuing to grow the program by expanding this into our medical group as well as some other sub-specialized specialties. We have also identified the need to revise a few of the plans to align with the specialty specific privileging.