Demonstrating Organizational Benefit of Pediatric APRN Practice in an Academic Medical Center

Purpose:
Determine APN “provider-specific” quality and productivity metrics and develop a means for tracking these metrics systematically.

Significance:
Academic medical centers have become more dependent on APN services to assure patient outcomes and close gaps left by ACGME resident work hour reductions. But with this dependence, cost has risen without a means of documenting benefit and outcomes (return on investment).

Strategy and Implementation:
Based on previous work of Griffin, et al (2007), the APN leadership team set about to distinguish the aspects of APN practice that are driven by the APN “providers” within the hospital. Once these metrics were determined for each APN group (n=8), we then compared the metrics to the medical center's “pillar goals” for the fiscal year. The categories included People, Service, Quality, Growth & Finance and Innovation. We then adapted the Nursing Pillar Scorecard as the format for on-going tracking mechanisms. We then met with support services (Special Projects and IT) to automate as many aspects of the data collection from the EMR as possible, minimizing the amount of manual tracking each APN team had to do. Then, the scorecard was rolled out to each team for discussion and feedback. Once metrics are finalized (June 2011), the scorecards and data collection will begin in July 2011, with the beginning of the fiscal year.

Evaluation:
Each metric has established threshold, target and reach targets. Those metrics which have retrospective data will be compared to performance going forward via the scorecard. Strategies are developed for performance improvement for metrics below performance standards.

Implications for Practice:
As APN specific metrics are monitored, each team has the data to determine aspects of practice requiring review, evaluation and process improvement – allowing objective administrative decision-making for resource and manpower deployment for maximal impact on patient outcomes and process indicators.