Assessing the competence of APPs
The Medical Staff's Guide to Overcoming Competence Assessment Challenges presents MSPs with some of the most common issues they face when it comes to collecting practitioner competency data. Each competence challenge is depicted through a case study and solution, including sample forms to collect competency data.
One common challenge involves assessing the competence of advanced practice professionals (APP). Collecting data on APPs is difficult because most of their cases are attributed to the attending physician, and not directly tied to the APP.
The following is an excerpt from The Medical Staff's Guide to Overcoming Competence Assessment Challenges related to the assessment of APPs:
Similar to the process that was used for developing the AHP evaluation process, the medical staff director in the case study at the beginning of the chapter will need to identify a number of experts, both internally and externally, who can assist with how the APP competence assessment process needs to be organized. Members from the quality department, medical records, and nursing administration will be key members of the team, and APPs should be part of the process. It will also be helpful if a few APPs are included. Understanding APPs’ day-to-day experience within the organization will help the team create a process that works. Designating an APP committee to carry out FPPE and OPPE processes could improve the amount of data available for APP activity.
Prospective review, concurrent review (proctoring), or retrospective review are examples of the various ways to conduct a focused review or to evaluate privileged practitioners. The medical staff should work with APPs to define specific quality indicators and to collect data on an ongoing basis. Many APP disciplines may be evaluated utilizing the same quality indicators as their physician counterparts (e.g., CRNA and anesthesiologist; CNM and OB/GYN). If it is difficult or impossible to gather patient records showing that the APP participated in patient care, then the medical services professional (MSP) may reach out to the APP and request a list of patient records in which the APP was involved. For organizations that are still challenged with attributing care to the APP, it is helpful to both parties if the APP is notified ahead of time of the need to keep a list of activity for ongoing review. Once that list has been provided, a random number of records can be pulled and retrospectively reviewed by a peer or a physician, utilizing the same review forms that are used for physician review. However, it may be more appropriate to develop a review form that is tailored to the APP and the medical care that he or she provides under the supervision of or in collaboration with the sponsoring physician, including the documentation of consultation with the physician as appropriate.
When assessing competence of APPs, it is valuable to obtain an evaluation from the employing or supervising physician if applicable. MSPs should provide the individual with education regarding the form’s purpose and content. An evaluation from a relevant hospital staff member who has routinely observed the practice of the APP should be obtained to make sure that the practitioner is adhering to hospital policies and procedures and codes of conduct. An operating room supervisor could provide an evaluation of a PA who has first assistant duties, as could an anesthesiologist.