In the fast-paced and complex realm of critical care cardiology, delivering exceptional patient care is a shared objective among health care professionals. As the field continues to evolve, the significance of collaboration and teamwork in achieving optimal patient outcomes cannot be overstated. Advanced practice providers (APPs), including nurse practitioners (NPs) and physician associates, play an increasingly vital role in this setting, utilizing their expertise and skills to enhance patient care and optimize outcomes.

The use of collaborative care models that leverage the unique talents of APPs has garnered significant attention in recent years. Research studies have demonstrated that integrating APPs into cardiology critical care settings improves patient communication, coordination and tangible benefits. The collaboration between health care professionals, including APPs, has reduced mortality rates and decreased lengths of stay in the intensive care unit (ICU), enabling patients to recover more effectively and efficiently.

This article explores the role of APPs in critical care cardiology and examines how their incorporation into collaborative care models can enhance patient outcomes. Discussing the latest research findings, it seeks to shed light on the significant impact of APPs in this specialized field. By raising awareness, fostering recognition of the vital contribution of APPs, underscoring the importance of collaborative care, and inspiring further exploration and implementation of such models, this discussion aims to drive advancements in the dynamic area of critical care cardiology.

Evidence of Benefit

Recent studies provide robust evidence supporting the utilization of APPs in critical care settings. These studies consistently highlight the positive impact of APPs in improving patient outcomes, optimizing resource utilization, and enhancing the overall quality of care in critical care units. Kleinpell, et al., demonstrated that the involvement of APPs in essential teams of care led to reduced mortality rates, decreased length of stay in the ICU and greater patient satisfaction.¹

This group showed in another study that having APPs in critical care units was associated with reduced rates of health care-associated infections, improved pain management and enhanced patient satisfaction.²

Moreover, research conducted by Chaney, et al., further established that incorporating APPs into critical care teams resulted in lower costs and increased efficiency in resource utilization.³

These recent studies solidify the growing body of evidence supporting the integration of APPs into essential care settings, emphasizing their pivotal role in improving patient outcomes and delivering high-quality care to the critically ill population.

In addition to the valuable role of APPs in critical care, they also make valuable contribution to the field of cardiology. Gilliland, et al., examined the impact of interprofessional collaboration on processes of care and patient outcomes in a cardiology ICU.⁴

The study found that effective collaboration between physicians, nurses and APPs resulted in enhanced communication, coordinated care delivery and improved patient outcomes, including lower mortality rates and shorter ICU stays.

David, et al., focused specifically on the role of NPs in collaborative care within cardiology critical care units.⁵ Their findings revealed that the involvement of NPs in the cardiology team enhanced interdisciplinary collaboration, promoted shared decision-making and optimized resource utilization. Patients under the care of NPs experienced improved medication management, increased adherence to therapeutic regimens and better overall outcomes than those managed solely by physicians.

Notably, at 30 days, with an NP as part of the team compared with physicians only, there were lower rates for both patients returning to the emergency department (11.9% vs. 25%) and readmitted to the hospital (13.8% vs. 28.9%).

Furthermore, exploring the effectiveness of APPs in critical care cardiology, specifically for acute myocardial infarction (AMI), Fowler, et al., demonstrated that including APPs in the care team improved door-to-balloon time, reduced treatment delays and resulted in more timely interventions in patients with AMI.6 This collaborative approach led to better patient outcomes, including lower mortality rates and improved long-term cardiac function.

Collectively these studies emphasize the importance of collaboration and the significant role that APPs, such as NPs, play in enhancing collaborative care within cardiology critical care settings. Integrating these findings into clinical practice can help optimize care delivery, improve patient outcomes, and ultimately enhance the quality of care provided in these specialized units.

Being Part of the Team

The future of APPs in enhancing patient outcomes through collaborative care in the cardiology critical care setting looks promising. Collaboration between health care professionals, including APPs, can lead to better communication and coordination, critical in a fast-paced, high-stress environment like the cardiology urgent care setting. By working together as a team, APPs can help streamline patient care, improve efficiency, and promptly address all aspects of a patient's condition.

Notably, hard outcomes, such as lower mortality rates and shorter ICU stays, are improved when APPs are included in the critical care team. APPs are trained to manage complex and acute care situations, and their presence can help ensure that patients receive timely and appropriate interventions. Additionally, their ability to provide continuity of care can lead to better patient outcomes.

In the future, APPs will likely continue playing an essential role in the cardiology critical care setting. Their advanced level of training and expertise makes them valuable members of the health care team, and their ability to provide collaborative care can lead to improved patient outcomes.

As the demand for critical care services continues to grow, integrating APPs into the cardiology urgent care setting will help meet the needs of patients and enhance the quality of care provided. By leveraging their advanced training and expertise, APPs will undoubtedly continue to revolutionize collaborative care and make a remarkable impact on the future of patient outcomes in this specialized area of medicine.

Grab Your Earbuds!

Don't miss the new Conversations With Critical Care Cardiologists series from ACC CardiaCast. Click here to listen to the first episode with Shashank S. Shah, MD, FACC, and Rosy Thachil MD, FACC, interviewing leading experts in the field, Robert O. Roswell, MD, FACC, and Michael Solomon MD, MBA, FACC, chair and chair-elect, respectively, of ACC Critical Care Cardiology Section Leadership Council. Be sure to subscribe to the series.

This article was authored by Luis Enrique Farfan, MSN, AGACNP-BC, CCRN, CCA, an NP in the cardiac care unit at New York Presbyterian Hospital - Columbia University in New York. He is working on his DNP at Georgetown University in Washington, DC.

References

1. Kleinpell RM, Grabenkort WR, Kapu A, et al. Nurse practitioners and physician assistants in acute and critical care: A concise review of the literature and data 2008-2018. Crit Care Medicine 2019;47:1442-9.
2. Kleinpell RM, Kapu AN, Stempek S, et al. Developing and expanding APRN and PA teams: Strategies and lessons learned from five institutions. American Nurse Today 2020;15:25.
3. Chaney A, Beliles G, Keimig A, Porter I. Advanced practice provider care team models: Best practices from an academic medical center. J Ambul Care Manage 2022;45:126-34.
4. Gilliland J, Donnellan A, Justice L, et al. Establishment of pediatric cardiac intensive care advanced practice provider services. World J Pediatr Congenit Heart Surg 2016;7:72-80.
5. David D, Britting L, Dalton J. Cardiac acute care nurse practitioner and 30-day readmission. J Cardiovas Nurs 2015;30:248-55.
6. Fowler LH, Landry J, Nunn MF (2019). Nurse practitioners improving emergency department quality and patient outcomes. Crit Care Nurs Clin North Am 2019;31:237-47.