The Scope of Practice for Primary Cardiovascular Disease Prevention Expanded to Advanced Practice Providers: What Does the Data Show?

PURPOSE OF REVIEW: The review aims to explore the available literature on the role of advance practice providers (APPs) in the primary prevention of cardiovascular diseases (CVD). RECENT FINDINGS: CVD are the major cause of death and disease with the growing burden of direct and indirect costs. Globally, one out of every three deaths is due to CVD. A total of 90% of CVD cases are due to modifiable risk factors which are preventable; however, challenges are faced by the already overburdened healthcare systems where the shortage of workforce is a common constraint. Different CVD preventive programs are working but, in a silo, and with different approaches except in few of the high-income countries where specialized workforce such as advance practice providers (APPs) is trained and employed in practice. Such initiatives are already proven more effective in terms of health and economic outcomes. Through an extensive literature search of APPs' role in the primary prevention of CVD, we identified very few high-income countries where APPs' role has already been integrated into the primary healthcare system. However, in low- and middle-income countries (LMICs), no such roles are defined. In these countries, either the overburdened physicians or any other health professionals (not trained in primary prevention of CVD) sometimes provide brief advice on CVD risk factors. Hence, prompt attention is appealed by the current scenario of CVD prevention specifically in LMICs.

A Multidisciplinary Approach to Increase Compliance With Spontaneous Awakening Trials and Spontaneous Breathing Trials in the Medical Intensive Care Unit.

Prolonged mechanical ventilation can lead to undesirable outcomes, including reduced 6-month survival, increased hospital mortality, intensive care unit (ICU) length of stay, and physiological stress. A large academic medical center currently has a Spontaneous Awakening Trials/Spontaneous Breathing Trials (SAT/SBT) protocol with an SAT/SBT compliance goal of 80%; however, the medical intensive care unit's (MICU) SAT/SBT compliance rate was only 33% for FY2020. The Define-Measure-Analyze-Improve-Control (DMAIC) framework was used to guide this quality improvement project. Current processes and root causes for noncompliance were analyzed through chart reviews, a preimplementation staff survey, and meetings with stakeholders. Compliance rates were compared before and after implementation. Interventions included education, reminder fliers, weekly chart audits, and individualized weekly emails to noncompliant RNs and RTs. To achieve project sustainability, 2 unit champions were selected to continue the weekly emails and chart audits. Data were collected from 216 patients and 1063 patient ventilator days from October 2020 to October 2021. The SAT/SBT compliance steadily increased throughout the 13-month implementation period, except for 3 months. The preimplementation monthly SAT/SBT compliance rate was 26% in September 2020. After 13 months of project implementation, the SAT/SBT compliance rate was 64% in October 2021. There was no significant change in patient ventilator days pre- and post-quality improvement project. A multi-intervention implementation strategy consisting of education in-services, weekly chart audits, weekly emails to staff with current compliance rates, and reminder fliers can successfully increase SAT/SBT compliance rates. Utilizing unit champions provides sustainability.