Analysis of trends in nurse practitioner billing for emergency medical services: 2015-2018.

STUDY OBJECTIVE: Despite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality. METHODS: Medicare provider utilization and payment data between 2015-2018 was used to explore NP billing as compared to five other clinician provider types for common emergency services acuity codes (CPT codes 99281-99285) to determine services billed for levels of severity of illness and trends over time. Number of services billed by clinician provider type related to state policies on NP practice authority, location, and population characteristics was explored. RESULTS: NPs who independently billed for ED CPT codes (99282-99285), increased during this time and decreased for acuity code 99281 (minor and self-limiting). Overall, NPs saw a greater increase than all other providers in both the highest severity CPT codes of 99284 and 99285. The analysis revealed that type of clinician, state practice authority policy, number of NPs, and percent of population 65 years and older (by zipcode) and population size are positive predictors for services billed. The negative predictors were rurality, states which accepted the Medicaid expansion, having a higher number of non-English speaking residents, and non-emergency medicine clinicians. CONCLUSION: As a proportion of the providers independently billing in the ED, NPs are increasingly managing higher acuity patients as evidenced by billing percentage of the highest acuity CPT codes (99284 and 99285). During the same time period, ED MDs decreased their billing in the same categories. Current employment of NPs in the ED may not be fulfilling its original vision to care for the lower acuity patients in order to allow MDs to care for the more acutely and critically ill patients, and to increase the services for underserved populations in rural areas, those over age 65, and those with limited English language proficiency. Future research should investigate ED policies resulting in NPs as opposed to MDs seeing patients with greater severity codes.

Radiation Injury Treatment Network Medical and Nursing Workforce Radiation: Knowledge and Attitude Assessment.

OBJECTIVES: The Radiation Injury Treatment Network (RITN) is prepared to respond to a national disaster resulting in mass casualties with marrow toxic injuries. How effective existing RITN workforce education and training is, or whether health-care providers (HCPs) at these centers possess the knowledge and skills to care for patients following a radiation emergency is unclear. HCP knowledge regarding the medical effects and medical management of radiation-exposed patients, along with clinical competence and willingness to care for patients following a radiation emergency was assessed. METHODS: An online survey was conducted to assess level of knowledge regarding the medical effects of radiation, medical/nursing management of patients, self-perception of clinical competence, and willingness to respond to radiation emergencies and nuclear events. RESULTS: Attendance at previous radiation emergency management courses and overall knowledge scores were low for all respondents. The majority indicated they were willing to respond to a radiation event, but few believed they were clinically competent to do so. CONCLUSIONS: Despite willingness to respond, HCPs at RITN centers may not possess adequate knowledge of medical management of radiation patients, and appropriate response actions during a radiation emergency. RITN should increase the awareness of the importance of radiation education and training.

Respiratory Protection Considerations for Healthcare Workers During the COVID-19 Pandemic.

The COVID-19 pandemic has resulted in a surge of patients that exceeds available human and physical resources in many settings, triggering the implementation of crisis standards of care. High-quality respiratory protection is essential to reduce exposure among healthcare workers, yet dire shortages of personal protective equipment in the United States threaten the health and safety of this essential workforce. In the context of rapidly changing conditions and incomplete data, this article outlines 3 important strategies to improve healthcare workers' respiratory protection. At a minimum, healthcare workers delivering care to patients with confirmed or suspected COVID-19 should wear N95 respirators and full-face shields. Several mechanisms exist to boost and protect the supply of N95 respirators, including rigorous decontamination protocols, invoking the Defense Production Act, expanded use of reusable elastomeric respirators, and repurposing industrial N95 respirators. Finally, homemade facial coverings do not protect healthcare workers and should be avoided. These strategies, coupled with longer-term strategies of investments in protective equipment research, infrastructure, and data systems, provide a framework to protect healthcare workers immediately and enhance preparedness efforts for future pandemics.

National Assessment of Nursing Schools and Nurse Educators Readiness for Radiation Emergencies and Nuclear Events.

Nurses will play a crucial role in responding to a public health emergency resulting from nuclear war or other large-scale release of radiation into the environment and in supporting the National Health Security Strategy. Schools of nursing are ultimately responsible for developing a competent nursing workforce prepared to assess a population's public health emergency needs and respond to these low-frequency but high-impact events. This responsibility includes the provision of specific content and training regarding how to respond and care for patients and communities in the event of a nuclear or radiation emergency. To date, however, there has been a lack of empirical evidence focusing specifically on nursing schools' capacity to prepare nurses for radiation emergencies and nuclear events, as well as perception of risk. This study employed a cross-sectional survey administered to a nationwide sample of nursing school administrators and faculty to assess content, faculty expertise, planning, and perception of risk related to radiation emergencies and nuclear events.

Analysis of Emergency Health Care Workforce and Service Readiness for a Mass Casualty Event in the Republic of Ireland.

OBJECTIVE: Ultimately, a country's capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland. METHODS: A cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13. RESULTS: A total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence. CONCLUSIONS: The results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243-255).

Expanding educational opportunities in disaster response and emergency preparedness for nurses.

The past few years have witnessed a dramatic increase in the number of large-scale disaster events and the ubiquitous threat of weapons of mass destruction. These events have heightened recognition of the role of the nurse in disaster management and response. Enhanced capacity to respond to disasters and other public health emergencies will require a nursing workforce that is clinically experienced and possesses the knowledge and skills necessary to respond with confidence and authority. This article reports on how American schools of nursing have begun to address the challenge of workforce development and nurse preparedness. The University of Rochester Leadership in Health Care Systems in Disaster Response and Emergency Preparedness Program is described in detail.

Mental health worries, communication, and needs in the year of the U.S. terrorist attack: national KySS survey findings.

INTRODUCTION: To reduce the escalating rate of mental health/psychosocial morbidities in children and adolescents, NAPNAP initiated a new national campaign entitled Keep your children/yourself Safe and Secure (KySS). The objective of the first phase of this campaign was to conduct a national survey to assess the mental health knowledge, attitudes, worries, communication, and needs for intervention of children/teens, parents, and pediatric health care providers. This first report from the KySS survey describes the child/teen and parental findings. METHODS: A cross-section of 621 children/teens and 603 of their parents from 24 states completed the KySS survey during visits to their primary health care providers. RESULTS: The five greatest worries of both children/teens and their parents included knowing how to cope with stressful things in their lives, anxiety, depression, parent-child relationships, and problems with self-esteem. The majority of children/teens and their parents reported that they do not talk to their primary care providers about these issues. Participants expressed a multitude of needs and suggestions regarding how to better recognize, prevent, and deal with mental health problems. CONCLUSION: Opportunities must be created for children/teens and their parents to communicate their mental health worries and needs to each other and to their pediatric primary care providers to facilitate earlier diagnosis and treatment of mental health problems. Interventions are urgently needed to assist children and teens in coping with the multitude of stressors related to growing up in today's society.