Appropriate acute care education, certification, credentialing, and privileging are requirements for health care providers to function in a hospital setting.
Admission to inpatient facilities is determined by these health care providers.
National organizations such as the American Academy of Pediatrics and the Society of Critical Care Medicine have developed guidelines to determine appropriate practice settings for patient care.
System-based criteria are used to determine the need for pediatric intensive care admission and differentiate between level I and II units.
Acuity scoring systems are also used to determine patient acuity and risk of mortality and morbidity.
Hospital practice includes obtaining a history, which includes medical history, current medications, allergies, immunizations and exposures, family health history, psychosocial history, spiritual and cultural evaluation, followed by a thorough physical examination.
The development of differential diagnoses, problem lists, and a plan of care for management is the responsibility of the pediatric acute care team.
Medical consultation is the process whereby a referring practitioner requests the evaluation of a patient by another practitioner (the consultant) who possesses specialty-specific knowledge beyond that of the referring practitioner or in an attempt to gain a secondary opinion regarding an uncertain diagnosis.
The practitioner requesting a consultation should provide the consultant with the patient’s pertinent clinical information that led to the decision to consult. The consult request should clearly state the questions to be answered by the consultant. Although consult requests are often entered into the electronic health record (or via a written order), the consultation should always include verbal communication between the requesting practitioner and the consultant.
The consultant has a responsibility to understand the information requested by the referring practitioner.
The consultation should be provided in a timely manner given the urgency established by the referring practitioner.
The consultant should first obtain an independent history and physical examination and review of the patient’s current studies.
Recommendations should be provided directly in a written consult note to the referring practitioner in a succinct, clear format that includes necessary details for implementation of recommendations.
The written consultation findings should also be verbally discussed with the referring practitioner.
Recommendation.
The consultant provides his or her opinion regarding the patient’s diagnosis and management, including medications and/or further laboratory or radiologic studies.
Comanagement.
The practice of the consultant ordering medications and additional studies to manage the patient’s diagnosis.
Comanagement should occur only if agreed upon by the referring practitioner and consulting practitioner prior to the consult.
The key to successful, effective consultation is verbal communication between the referring practitioner and the consultant.
Interprofessional patient care is accomplished through an integrated approach by a clinical team of multiple disciplines.
The discipline of medicine includes physicians and surgeons, physicians-in-training (residents, interns), medical students, and physician assistants. Subspecialists are included in this listing.
The discipline of nursing consists of advanced practice registered nurses (APRNs), including population-specific nurse practitioners (NPs), nurse anesthetists, clinical nurse specialists, and nurse midwives. Nurses and nursing students are the largest component of this group.
Allied health professionals include pharmacists, respiratory therapists, social workers, psychologists, child life specialists, chaplains, paramedics, and others.
Designed to rapidly assess a patient and intervene promptly.
Requires rapid assembly of a team of providers skilled not only in their individual areas of patient care expertise but also in their ability to function as a team.
The leader of this team is generally a physician who receives immediate consultation from the other health care professionals in the team but who is responsible for making critical decisions regarding the plan of care.
Designed to diagnose and treat children with oncologic conditions.
Includes physicians, APRNs, staff nurses, pharmacists, dietitians, social workers, case managers, and chaplains.
Functions in an interprofessional manner with all members of the team contributing to the individual patient’s care and meeting as a group to discuss the patient’s needs.
While the physician may still be viewed as the leader for such a team, this team can make decisions through group consensus.
Teams can be led by providers other than physicians, but team leaders serve an essential role in teams as they facilitate decision making and exchange of information.
Dependent on cohesive teamwork.
Require effective team communication and process to facilitate communication.
Require critical information and infrastructure to access information.
TABLE 25.1 Role and Function of Physicians
Provider
Description
Attending physicians
Examine patients, obtain medical histories, order and interpret diagnostic tests.
Diagnose illnesses and provide patient health counseling.
Prescribe and administer treatments for patients.
Medical students
Complete 4 y of training at an accredited medical school.
2 y of didactic training.
2 y of clinical training under the supervision of experienced physicians.
Physicians-in-training
Residents
Train in an area of general practice, such as pediatrics or surgery, under the supervision of experienced physicians.
Fellows
Train in an area of specialized practice, such as endocrinology or cardiothoracic surgery, under the supervision of experienced physicians.
Physician assistants
Trained to practice medicine under the direction and supervision of an attending physician.
Responsibilities include clinical decision making and a broad range of diagnostic, therapeutic, preventive, and health maintenance services.
Open communication.
Allows team members to share concerns about safety or quality of patient care and to ask questions to improve understanding of patient care.
Interprofessional rounds provide an opportunity for open communication and collaboration between team members.
Another essential feature of successful team work.
Review team performance in relation to professional collaboration, patient outcomes, team function, and to provide and receive constructive feedback to improve team performance.
Improved communication and collaboration.
Higher job and career satisfaction.
Less burnout and increased sense of autonomy.
Patients and families.
Shorter lengths of stay.
TABLE 25.2 Role and Function of Nurses
Provider
Description
Nurses
Record patients’ medical histories and symptoms.
Perform diagnostic testing.
Administer treatments and medication.
Help patients with follow-up care and rehabilitation.
Teach patients and families.
Nursing students
Complete nursing education preferably through baccalaureate program.
All nursing education requires classroom instruction and supervised clinical experiences in hospitals and other health care facilities.
Advanced practice registered nurses (APRNs)
Nurses with additional graduate-level didactic and clinical training in a particular population.
Educational programs typically award a master’s or doctoral degree in nursing.
Four types of APRNs: NPs, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists.
Nurse practitioners (NPs)
Deliver primary and/or acute care in a variety of clinical settings.
Diagnose and treat common acute illnesses and injuries.
Perform physical examinations.
Manage chronic health conditions.
Primary care pediatric NPs
Provide health maintenance and well-child examinations, developmental screenings, school physicals, immunizations, anticipatory guidance, and diagnosis and treatment of common childhood illnesses.
Acute care pediatric NPS
Trained to meet the specialized physiologic and psychological needs of children with complex acute, critical, and chronic health care needs.
Neonatal NPs
Manage the complex health care needs of the critically ill and convalescing neonate and family in an inpatient neonatal setting. NNP’s are currently trained to manage infants and toddlers to the age of 2.
Clinical nurse specialists
Expert clinicians who provide care in a specialized area of nursing practice (e.g., population, setting, or type of care), offer expert consultation to staff nurses, and implement improvements in health care delivery systems.
Certified registered nurse anesthetist
Providers who specialize in anesthetic care of patients in all settings.
Improved quality of care as measured by quality core measure performance.
Interprofessional education is the act of sharing and delivering pertinent knowledge among health care professionals, which can include a variety of topics, settings, and leaders.
The ultimate goal of interprofessional education is to improve patient health care delivery outcomes through collaboration and shared dissemination of evidenced-based practice knowledge.
Evidence supports the significance and utility of interprofessional education and collaboration with the direct correlation to improved health care outcomes, work satisfaction, peer support, and creating a positive teamwork environment among health care providers (Zwarenstien, Goldman, & Reeves, 2009).
Interprofessional education is a responsibility for all clinicians, providers, and managers.
Modern health care is evolving into an interprofessional team care approach; interprofessional education is a vital and essential component.
TABLE 25.3 Role and Function of Allied Health Professionals
Provider
Description
Pharmacists
Distribute medications prescribed by other providers.
Inform patients about medications.
Advise practitioners on selection, dosages, interactions, and side effects of medications.
Respiratory therapists
Evaluate, treat, and manage patients of all ages with respiratory illnesses and other cardiopulmonary conditions.
Dietitians
Integrate and apply the principles derived from the sciences of food, nutrition, biochemistry, physiology, food management, and behavior to achieve and maintain health status of patients in a variety of clinical settings.
Provide medical nutrition therapy and the use of specific nutrition services to treat chronic conditions, illnesses, or injuries.
Occupational therapists
Promote health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction.
Address the physical, cognitive, psychosocial, sensoriperceptual, and other aspects of performance in a variety of contexts and environments.
Physical therapists
Provide services to patients recovering from accidents or illness and people with disabilities.
Improve patients’ strength and mobility, relieve pain, and prevent or limit permanent physical disabilities.
Speech therapists
Evaluate, diagnose, and treat speech, language, and swallowing disorders in individuals of all ages, from infants to the elderly.
Treat speech, language, and swallowing disorders.
Social workers
Assist individuals, groups, or communities to restore or enhance their capacity for social functioning while creating societal conditions favorable to their goals.
Help prevent and mitigate crises and counsel individuals, families, and communities to cope more effectively with the stresses of everyday life.
Chaplains
Help people in health care settings cope with a life-changing medical situation.
Child life specialists
Trained professionals with expertise in helping children and their families overcome life’s most challenging events.
Promote effective coping through play, preparation, education, and self-expression activities.
Provide emotional support for families.
Encourage optimal development of children facing a broad range of challenging experiences, particularly those related to health care and hospitalization.
Case managers
Help patients understand their current health status, what they can do about it and why those treatments are important.
Guide patients and provide cohesion to other professionals in the health care delivery team.
Emergency medical technicians (EMTs) and paramedics
Trained to provide emergency care to people who have suffered from an illness or an injury outside the hospital setting.
Work under protocols to recognize, assess, and manage medical emergencies and transport patients to facilities where they can obtain definitive medical care.
EMTs provide basic life support.
Paramedics provide advanced life support.
TABLE 25.4 Role and Function of Administrators and Leaders
Provider
Description
Medical director
A physician who provides administrative and clinical leadership for a clinical area, such as an inpatient unit, an outpatient clinic, or a clinical program.
Nurse manager
A nurse who provides administrative and clinical leadership for a clinical area, such as an inpatient unit, an outpatient clinic, or a clinical program.
Nursing supervisors
Nurses who are responsible for clinical and administrative oversight of a given clinical area during a designated period of time.
Health unit coordinators
Administrative professionals who help maintain a health care facility’s service and performance by preparing documents, transcribing medical orders, maintaining patient charts and records, coordinating patient activities for the unit, ordering supplies, and communicating with the other clinical departments.
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