Multidisciplinary Teams: How do we get there?

While the current mandates for restricted work hours for residents and fellows are giving them much needed relief from their long shifts, the resulting shortage of providers and the elevated importance of quality and patient safety measures produce new challenges for multidisciplinary teams. Traditional models of care will no longer be enough to provide safe, effective, and efficient patient care.  New, strategic, team focused-collaborations will drive “Multidisciplinary Teamwork” oriented solutions.

To alleviate this shortage and address quality initiatives, a team of Advanced Practice Providers (Advanced Practice Nurses and Physician Assistants) and residents in collaboration with the attending physician will be the new “Hybrid Model of Care,” according to Joshua Koch, MD, Medical Director of the CICU at the Children’s Medical Center of Dallas and Assistant Professor of Pediatrics at UT Southwestern Medical Center.  His vision of bridging the gap with Advanced Practice Providers to provide quality medical care is gaining attention as he makes the case that hospitals must utilize nurse practitioners and physician assistants in new roles. 

Explore Pediatric Advanced Practice Jobs 

Traditionally, APPs worked in clinic settings or specialty units such as the NICU, but they are qualified for and are moving into areas of all medical specialties as a result of their advanced education and clinical experience and expertise. The addition and expansion of the Advanced Practice Provider role on multidisciplinary teams brings new challenges and opportunities to achieve the highest quality and outcomes.

Dr. Koch spoke at the 2013 Pediatric Critical Care Colloquium, last November 2-5, in Washington, DC.  You can view Dr. Koch's presentation here to learn more about his ideas on building and implementing multidisciplinary APP teams including the importance of training, leadership, teamwork, and communication strategies, and more.  Not only is his focus on the needs of today, but his vision includes ongoing professional development, education, and research to provide strategies to bridge the gap now and in the future.

Melnic Consulting Group works with children’s hospitals nationwide to provide highly skilled Advanced Practice Providers (APPs-Pediatric Nurse Practitioners and Physician Assistants).  We have the unique opportunity to learn from the challenges and successes in the implementation of “Multidisciplinary Teamwork.”  Please see the following resources as you seek to grow and develop your teams:
APP Teams and Care Coordination Framework, Josh Koch, MD
Advanced Practice Provider Retention Strategies

To inquire about these jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Pediatric Cardiac Nurse Practitioner Model and Orientation

In an effort to provide more effective, efficient and higher quality patient care, children’s hospitals across the U.S. are turning toward a collaborative practice model.  During the 2014 NAPNAP Conference, featured speaker, Lindy Moake, RN, MSN, PCCNP, from Children’s Medical Center of Dallas, shared the benefits they have experienced from a collaborative practice model in the Heart Center at CMCD.

Lindy Moake is the Heart Center APS Manager at CMCD and has been a driving force in the collaborative practice model transition.  Working very closely with the Chief of Cardiothoracic Surgery, Chief of Cardiology, and Medical Director of the CVICU, Lindy and the leadership team at CMCD developed a sustainable collaborative practice model that starts with a standardized 6 month orientation process for Advanced Practice Providers.  An orientation manual outlines weekly guidelines and recommendations for patient assignments and readings, and each newly hired Advanced Practice Provider is matched with two primary preceptors.

View the presentation given by: Lindy Moake, RN, MSN, PCCNP

Pediatric Cardiac Nurse Practitioner Model and Orientation Presentation

Examples of measurable outcomes achieved by using Advanced Practice Providers include:

• Decrease in major complications (i.e., ECMO)
• Decrease in inpatient CPR events 
• Hospital LOS has decreased dramatically
• 2013 LOS for infants with SV physiology decreased from 63.1 days to 45.4 days a difference of 17.7 days 
• Interstage mortality in this same patient population has decreased from 17% (2009) to < 2% 
• Dramatic increase in family satisfaction scores. 

Learn more about the APP Orientation Process in the Heart Center at Children’s Medical Center Dallas.

Join the Advanced Practice Provider team in the 

Heart Center at Children’s Medical Center Dallas.  

Pediatric Nurse Practitioner, CVICU and CCU – Dallas, TX  

Pediatric Nurse Practitioner, Heart Transplant - Dallas TX

To inquire about these jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Evolving Roles of Advanced Practice Nurses and the Structures that Work

During the 2014 NAPNAP Conference, Melnic Consulting Group President Jill Gilliland moderated a two part panel discussion on the “Evolving Roles of Advanced Practice Nurses and the Structures that Work.”  Presenters represented many of the country’s leading children’s hospitals who shared their experiences and impressions of the advantages, challenges and strategies of developing or growing a structured program in a hospital setting.  Three models for success were presented that included some components of a strong model: An effective orientation program, cultivating advanced practice leaders and identifying outcomes impacted by nurse practitioner care.  Discussion also included multidisciplinary teams, their role, relationships and influence and how the contribution of the Advanced Practice Nurse impacts patient care delivery.  At the end of the presentations, panel members participated in a lively discussion with attendees who shared some very thoughtful questions and observations regarding structured programs and the evolving role of the advanced practice nurse.

Access Session Presentations Here

(Listed in the Advanced Practice Structure Section)

View Video from the NAPNAP Presentation

(More video from this session coming soon!)

A big thanks to the panel members who participated in this insightful session:

Colleen Miller, Director of Advanced Practice, Phoenix Children's
Lindy Moake, APS Clinical Manager, Heart Center, Children's Medical Center Dallas
Carmel McComiskey, Director, Nurse Practitioners, University of Maryland Medical Center
Suzette Stone, Assistant Director of Advanced Practice Providers, Acute Care, Texas Children's
Shannon Fitzgerald, Chief, Advanced Practice Services, Seattle Children's Hospital
April Kapu, Assistant Director of APN Practice - Critical Care, Vanderbilt University Hospital

To inquire about PNP jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Advanced Practice Nursing Structure

Advanced Practice Nursing Structure

Advance Practice Structure Click here and scroll down to Advanced Practice Structure to see a detailed analysis of the Stucture and Billing Practices, with answers to the following questions:

Who is in charge?

How do we bill for APNs?

How do we increase patient access?

How do we increase autonomy for APNs?

Who can help us develop Physician relationships?



To inquire about these jobs visit Melnic Consulting Group or contact:Jill Gilliland800-886-7906jill@melnic.com