Advanced practice clinicians able to provide most levels of orthopedic care
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NEWPORT BEACH, Calif. — Advanced practice clinicians or orthopedic hospitalists can optimize patient care through approaches that are as autonomous or collaborative as the orthopedic surgeon or department needs, according to a presenter.
At the Interdisciplinary Conference on Orthopedic Value-Based Care, Michele M. Hughes, DNP, APRN, ACNP-BC, ONP-C Nursing, discussed models of care provided by individuals who are advanced practice clinicians (APCs). These can include nurse practitioners and physician assistants (PA).
Hughes, who has worked in such a role for about 20 years, said she has an expanded resource list “that proves that APCs can be great providers, provide equal level of care, but see good outcomes, too.”
The three models of care provided by orthopedic APCs that Hughes discussed included a highly collaborative model with little autonomy; a model in which the APC is fairly autonomous, but only with less complex patients; and a third model in which the APC acts more like a resident or junior attending in terms of duties performed.
Because the first model is characterized by high collaboration between the surgeon and the AP, and little autonomy on the part of the APC, “typically you have a one-on-one model,” where the surgeon and nurse practitioner or PA work side by side, according to Hughes.
This collaboration may take place in the inpatient setting or extend to the office, clinic or OR, she said.
Hughes likened the position to a “physician extender role, where they’ll round with the surgeon,” but without direct surgical responsibility.
“But that does allow, just by being that extension, the surgeon to be a little more quick and efficacious in the workflow of the day,” Hughes said.
With the second model Hughes discussed, the APC provides autonomous care for less complex patients. She said this is sometimes in conjunction with a one-on-one approach. However, the more frequent model, Hughes said, is when one APC works with two or more physicians.
This is done in such a way that the APC is more autonomous than with the first model, according to Hughes.
“What that does is it increases the opportunity for surgeons to be available to care for the more complex patients, see them in the office, respond to those needs, get those patients scheduled for surgery a little faster, see their patients, that sort of efficiency,” Hughes said.
With the third model, “you have a very autonomous provider who requires very little supervision, but also is seeing just as complex patients” as a resident or junior attending surgeon, Hughes said.
APCs who follow this model are “sometimes carrying as much or a similar load as their surgeon colleagues,” but they are also highly collaborative in their approach, according to Hughes.
“That surgeon is always available to the provider that you see,” she said.
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Hughes MM. Orthopaedic hospitalist – optimizing care with an inpatient NP/PA. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; April 29-30, 2022; Newport Beach, Calif.
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