Associate Professor University of Arizona College of Medicine Phoenix Phoenix
Introduction: Team burnout and lack of involvement have escalated in the post COVID ICU. Our team growth from 2 to 8 APPs required rapid identification and implementation of education and development of the team. Varying levels of experience required rapid implementation of structured onboarding program, continuing education process and physician mentorship to foster interdisciplinary team dynamic.
The objective was to develop and implement a team training and education curriculum for new graduate APPs starting in the medical intensive care unit at a university Hospital with minimal utilization of APPs prior to COVID.
Methods: A quality improvement project that included a multidisciplinary team using a rapid cycle improvement PDSA approach was conducted. A review of what had been created across other ICUs and partnered with a needs assessment to create the curriculum. A key driver allowed the team a visual to follow.
A six month, multidisciplinary, onboarding process was created with benchmarks for growth and integration. Rapid identification of remediation was assessed with formal evaluations monthly. Continued educations sessions bimonthly after the onboarding program was initiated to facilitate continued growth. Physician mentorship was implemented to foster cohesive interdisciplinary team dynamic. Guidelines were in place for mentorship. Simulation and procedure competency was also a part of the curriculum.
Results: A total of 8 APPs participated in the experience. APPs were able to integrate into the ICU team with confidence and a feeling of full support from physicians and senior APPs. The new graduate APPs report a sense of collaboration and mentorship with the physician team members and senior APPs. APPs have become an intracule part of the ICU provider team, managing 10-20 ICU patients in collaboration.
Conclusions: The multidisciplinary approach to team training and education allows for improved confidence and communication among the APPs. Continuing metrics and follow through are needed to see if patient outcomes are altered by this change. Spread is an integral part of quality improvement projects, and the team has been successful at spread of the longitudinal curriculum across ICUs. A development of advanced onboarding is being developed across the system for APPs based on our experience.
