Advanced Practice Provider - Cardiac Critical Care Unit

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CCU overview:

Highly specialized unit caring for cardiogenic shock patients with significant portion of them requiring mechanical circulatory support devices (MCS).

The patient population includes

• Any VAD or transplant patients who have medical and occasional surgical critical care issue.
• Post-procedural patients: Post-PCI complicated by perf, vascular issues or cardiac arrest, occasional post-TAVR with heart block or vascular issues, post Alcohol septal ablation with heart block, post VT ablation with cardiogenic shock, hypotension or vascular issues.
• Valvular patients with cardiogenic shock or respiratory failure to optimize for definitive intervention
• Post-Cardiac arrest patients due to cardiac etiology (MI or arrhythmia)
• Hypertrophic cardiomyopathy patients who are critically ill due to arrhythmia or medical illnesses.
• Cardiogenic shock patients are usually decompensated HF patients or acute MI cardiogenic shock and occasionally other causes of cardiogenic shock. Majority of those are supported by MCS devices.

CCU is 10 beds unit but space is flexible and CCU patient overflow to other units (typically non-MCS). The average census is about 8-9 with significant variability ranges from (4 to 16)

Team structure:

Daytime: The current daytime CCU team structure include:

• One medicine resident and one medicine intern
• ICU attending (The CVC ICU group is 13 members who are either anesthesia/critical care or Pulm/critical care with experience in cardiovascular ICU)
• General cardiology fellow (occasionally a critical care fellow replaces the cardiology fellow)

The CCU day team are present from 6:30 AM to around 6:30 PM. The rounding starts at 8 AM with HF attending and fellow on mutual HF patients tilla round 9:30 AM then the CCU team round with the general cardiology (GC) attending on GC patients from 9:30 to around 10:30.

Nighttime: The current nighttime team structure include:

• A dedicated 3rd year resident who covers CCU and admit to CCU
• Inhouse cardiology fellow
• ICU attending (a member of the CVC ICU group) who cover both CCU and CTU

Vision/Plan: CCU census and acuity has been increasing and the expectation that the census will continue to grow. The vision is to develop collaborative hybrid team including physician and APP to care for the CCU patients. We envision that we will need one APP to join the CCU daytime team as well as one APP to join the CCU nighttime team.

Training/Schedule : Given the specialized care in the CCU, we do expect that the APP will require 6 months period of training (around 40 hours a week, 3 shifts of 13 hours shifts). The training in the first 3 months will be with the day-team and then the subsequent will be daytime and nighttime training.

As we reach out full complement of APP in the future. It is expected that APP will have a mix of daytime and nighttime shifts on rotational basis.

The daytime shift will be from 6:30 AM to 7 PM and the nighttime shift will be 6 PM to 7 AM

Reporting:

APP will report administratively to the CCU CND and clinically to the CCU medical director

Responsibilities:

• Development, evaluation and modifications of treatment plans as patient condition warrants
• Supervise protocols and ensure compliance of studies
• Participate in diagnostic and therapeutic procedures as indicated by patient condition
• The APP will be able to provide clinical consultation and participate in medical research.
• Review/prescribe therapeutic orders for patients
• Prescribing and performance of diagnostic and therapeutic interventions
• The APP practices in collaboration with the attending physician and other members of the multidisciplinary team to insure optimal patient outcomes.
• Comprehensive assessment, diagnosis and treatment
• The APP works in conjunction with the primary nurse to provide patient and family centered care, providing psycho-emotional support, educational support and discharge planning that is individualized and comprehensive.
• The APP will participate in continuing education, quality improvement initiatives, clinical outcome evaluation and monitoring.

Qualifications

• Current MA Nurse Practitioner license required or Physician Assistant degree and certification.
• Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process.
• Ability to provide primary care for a caseload of patients according to practice guidelines and hospital policies, procedures and protocols.
• BLS certification required. Additional certification may be required in specialty units.
• Master's degree in Nursing required.

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