Doctoral Project Defense: James Byass-Rascoe

Candidate: James Byass-Rascoe

Major: Doctor of Nursing Practice

Advisor: Catherine Tierney, D.N.P.

Title: Clinical Performance Standardization and Improvement Among Advanced Practice Providers with the Addition of Cognitive Aids in Practice

In a large urban university-affiliated academic hospital in western Pennsylvania, the advanced practice providers (APPs) who provide care in the cardiothoracic intensive care unit CTICU are tasked with assessing, diagnosing, managing care, and responding to the clinical deterioration of patients. During clinical deterioration or admission of an acutely ill patient, the assessment must be completed quickly, and the appropriate data reported to supervising physicians. The practice site found that the amount of data collection and timeliness of contact with the supervising physicians varied among the APP group. APPs with lesser experience sometimes gathered insufficient data or did not recognize the need to contact the supervising physicians sooner. The supervising physicians became concerned over the timeliness of interventions and the inconsistent data collected among the APP group. The needs assessment for this project noted a gap in the APP’s experience and the need for formal onboarding materials and written resources with the most up-to-date evidence-based practice and institutional protocols. This quality improvement project aimed to improve APP data collection practices and standardize APP practice using a series of cognitive aids known as the CTICU Clinical Management Guidelines (CTICUCMG). This project aimed to increase supervising physician satisfaction with APP performance and evaluate the effect of practice standardization on patient length of stay in the ICU. The APPs were surveyed using the validated NoMAD survey in October and again in December 2022. Length of stay (LOS) was not affected during this project. The quality improvement project showed no statistical significance in the findings but clinical significance with the acceptance of practice improvement with the APP group. Standardization of practice alone will not affect the patient’s length of stay. Although the results showed no statistical significance, 67% of the APPs reported that the CTICUCMG were a regular part of the practice, and 100% reported that the guidelines would become a normal part of their practice. In addition, the APPs overall showed improvement in familiarity and satisfaction with using the CTICUCMG.