Physician Assistant/APRN - CVICU - Hartford, CT

Cardiac Critical Care

Completes thorough but appropriately focused evaluations of pediatric patients (from neonates to adolescents and young adults), including competent and age appropriate histories and examinations. Identifies level of illness severity in a timely manner. Presents thoughtful assessments to the supervising physician and works towards prescribing necessary care plans. Performs appropriate procedures under their responsibility with the appropriate guidance. Knows when and how to seek assistance.

Cardiac Critical Care includes the knowledge and skills to diagnose and manage children with life threatening illnesses and injuries. These include conditions that cause respiratory, circulatory, neurologic, renal or hepatic failure, severe infectious, hematologic, or immune disorders, and poisoning. In addition, privileges include care of children needing cardiopulmonary resuscitation, stabilization during transport, complex pre- and post-operative care.

A list of specific core management modalities used by the critical care APP includes, but is not limited to (with supervision of CVICU attending, PICU attending, Cardiology attending, and CT Surgery attending):

• Application and regulation of extracorporeal respiratory, renal, and circulatory assist devices (ECCS, ECMO, LVAD)
• Application of cardiac output monitoring
• Application of respiratory therapy
• Anticoagulation
• Bag mask ventilation
• Elective and emergency management of the difficult airway including use of LMA (laryngeal mask airway), lightwand stylet, flexible scope, obturator airway and other techniques
• Enteral nutrition
• Brain protective strategies using medications, osmolar agents, temperature regulation, and ventilation-
• Interpretation of continuous EEG monitoring
• Interpretation and management of acid base disturbance
• Interpretation and management of fluid, electrolyte, and metabolic abnormalities
• Interpretation of blood gases
• Interpretation of electrocardiogram and echocardiogram
• Interpretation of intracranial pressure monitoring, and management of intracranial pressure abnormalities
• Interpretation of vascular and cardiac chamber pressure measurement
• Medical management of patients during intra and interhospital transport
• Medical modulation of the autonomic nervous system
• Parenteral nutrition
• Respiratory support weaning techniques
• Thrombolytic therapy
• Tracheal intubation (oral and nasotracheal, emergency perlaryngeal)
• Tracheotomy Care
• Use of blood component therapy
• Use of inotropes, vasoconstrictors, vasodilators
• Use of mechanical ventilation, positive end-expiratory pressure, and continuous position airway pressure
• Use of medications to promote a brief or prolonged state of analgesia, anxiolysis, moderate or deep sedation, or emergency and non-emergency general anesthesia
• Use, zeroing, and calibration of transducers, use of amplifiers and recorders of physiologic parameters

Diagnostic and Therapeutic Procedures include:

• Application of hypothermic therapy
• Arterial puncture
• Emergency cardiac pacemaker insertion and application
• Emergency cardioversion, defibrillation, transcutaneous pacing
• Exchange transfusion
• Insertion arterial catheters
• Insertion of hemodialysis and peritoneal dialysis catheters
• Insertion peripheral and central venous catheters
• Insertion pulmonary artery catheter
• Insertion of umbilical catheters
• Interpretation of respiratory mechanics studies tests
• Laryngoscopy
• Lumbar puncture
• Needle and tube thoracostomy
• Paracentesis
• Point of Care Ultrasound for the insertion of vascular catheters, pericardiocentesis, thoracentesis and paracentesis
• Thoracentesis

Consultations and care for adults 21 years of age and over with congenital cardiac anomalies (as approved by the Hospital CMO and Leadership

Perinatal and fetal consultations for congenital cardiac anomalies.

FPPE Guidelines

• Concurrent observation of one-week on-service/on-call rotation by an Active member of the Department.
• Peer review through the departmental quality assessment activities

Criteria for Reappointment

• Documentation confirming CME activity during the past 24 months consistent with state licensing requirement.
• Provide proof and maintain current ACLS, PALS and BLS
• Sedation
• Sedation is considered a core privilege of Cardiac Critical Care Medicine under the guidelines established in Connecticut Children's Policy: Procedural Sedation
• Privileges for sedation must be requested separately by all physicians and Advanced Practice Providers with clinical privileges in the CVICU per Connecticut Children's Medical Executive Committee. It is expected that practitioners requesting privileges in the CVICU request such privileges.
• Ongoing review for safety and quality as determined by Chief, Cardiac Critical Care and outcome reporting through Enterprise Quality and Safety Office will be required to ensure quality of care and best outcomes.
• Advanced Airway Management
• Participation in Operating Room or simulation-based airway management experience regularly OR successful management of actual patients requiring advanced airway management up to and including endotracheal intubation in accordance with Connecticut Children's policy.

Medical knowledge

• Clinical knowledge. With guidance, applies basic medical knowledge to common diagnoses in department. Expands clinical knowledge by asking insightful questions, seeking knowledge independently and reading medical literature critically. Incorporates issues of child health advocacy, preventive health care, ethical dilemmas, and cost of tests and therapies.
• Diagnostic evaluation . Provides basic evaluation (e.g., diagnostic testing and consultation) for common diagnoses. Increasingly recommends broad evaluation based on an unfocused differential diagnosis. Reports results of diagnostic studies, identifying clinically significant results with guidance.

Patient history. Gathers patient information following a template. Adapts the template with guidance and as appropriate to filter and prioritize pertinent positives and negatives based on broad diagnostic categories or possible diagnoses.

Patient care

• Clinical reasoning. Presents clinical facts (e.g., history, exam, tests, consultations, etc.) to preceptor, supervising physician, and care team. Ultimately generates an unfocused differential diagnosis based on the clinical facts.
• Organize and prioritize patient care . Completes assigned patient care responsibilities focused on individual patients.
• Patient management. Increasingly participates in the creation of patient management plans. Discusses plans with patients/families.

Interpersonal and communication

• Patient and family centered communications. Works to establish rapport with patients/families. Develops therapeutic relationship in straightforward encounters. Seeks guidance when adjusting communication strategies in order to mitigate barriers and meet patient/family expectations.
• Interpersonal and team communication. Participates within the inter-professional team. With guidance, clearly and appropriately requests consultation, presenting relevant patient information to supervising physician .
• Communication within the Health Care System. Accurately and timely records information in the patient record. Responds in a timely fashion and in appropriate form (e.g., in-person, HER, telephone, email) to requests. Seeks guidance on best mode of communicating when uncertain.

Practice-based learning and improvement

• Evidence-based and informed practice . Develops and articulates clinical questions. Accesses available evidence with appropriate guidance.
• Reflective practice and commitment to personal growth. Participates in feedback sessions. With guidance from lead/manager, develops professional goals and a learning plan, incorporating feedback and performance data.

Professionalism

• Performs responsibilities in a thorough and timely manner. Proactively seeks guidance in new, complex and/or stressful situations.
• Participates in creating, promoting and sustaining a healthy and productive team and work environment. Familiarizes self with institutional resources that are meant to promote well-being.

System-based practice

• System navigation for patient centered care-coordination of care