NPs Are a Vital Part of Surgical Institute's Acute Care Surgicalist ServiceMay 20, 2021 12:00PM ● By Med Magazine
When Certified Nurse Practitioner Rebecca McDugle joined Surgical Institute of South Dakota (SI) 11 years ago, she was the entire advanced practice arm of SI's Acute Care Surgicalist Service. The service provides Avera McKennan Hospital with round-the-clock general surgery coverage. McDugle worked entirely in the hospital, rounding, helping with discharges and admissions, and providing consultations in collaboration with the SI surgeon-on-call.
Now more than a decade later, as the demand for both elective and urgent surgical care continues to expand, so has the need for skilled NPs to support the Surgicalist program.
"We grew from six surgeons, myself, and a PA who worked solely with surgeons on elective surgeries, to seven surgeons, six advanced practice providers (APPs) who work with them in the elective practice, and four nurse practitioners dedicated to the Surgicalist program," says McDugle.
Each week, two SI surgeons step away from their elective surgery practices to provide assessments, procedures, or urgent surgeries in the hospital. One surgeon covers the days while the other covers nights. The 24-hour coverage reduces waiting time for patients and the seven-day schedule helps to reduce the number of times a patient must be handed off to a new doctor, ensuring continuity of care. Each acute care surgeon is joined by a dedicated APP who assists them in the OR that week.
McDugle and the other Surgicalist NPs keep the entire program running smoothly by managing the wide range of vital non-surgical tasks.
"It's our job to manage the service so that the surgeons can go and operate, which is what they need to be doing," says McDugle. "In addition to rounding and admitting patients that we know are coming in from outside facilities or through the ER, we work closely with social workers and case managers to coordinate services for patients who are being discharged."
In addition to managing patients' transitions in and out of the hospital, the Surgicalist NPs also field calls from nurses on the surgical floors to troubleshoot problems. "The nurses are our eyes and ears at the bedside and we make a point to talk to all of them while we're rounding so we understand what is going on with each patient and can be ready to help," says McDugle.
Although there is always a surgeon on site, as well, every NP in the Surgicalist program has a background in either intensive care or the emergency room. "We are all used to very high acuity patients," says McDugle. "The surgeons understand that we have a scope of practice and that we are very good at handling emergency situations, if needed."
Just as importantly, the Surgicalist NPs have the flexibility to spend time with case managers, social workers, and the 30 to 35 surgical inpatients they typically have on any given day, discussing their care plans, and answering questions. If a patient is being discharged to a swing bed closer to home, the Surgicalist NP will update the receiving facility on the patient's status and expectations and answer their questions, too. McDugle says her phone is rarely quiet.
"My job involves a lot of phone calls, a lot of coordination of care, and a lot of communication," she says. "We try to be very open. Our numbers are everywhere."
Daily acute care team meetings that include that week's hospital-based surgeons, the APP that will be assisting in the OR, and that day's Surgicalist NP, help ensure that everyone is up to speed on the status of every patient, every day.
"That is our opportunity to talk through each patient that is in the hospital, why they are there, what are the concerns, and what is the plan for the day," says McDugle. "It's a great learning opportunity for everyone at the table and it really helps with continuity of care. Continuity of care is a major emphasis for us."