Snyder J V, Sirio C A, Angus D C, Hravnak M T, Kobert S N, Sinz E H, Rudy E B
Department of Anesthesiology, School of Medicine, University of Pittsburgh Medical Center, PA 15213.
New Horiz. 1994 Aug;2(3):296-304.
As public concern for quality control of medical care at the beginning of this century forced regulations on medical licensing of physicians, the forces of change in health care are again substantial, this time driven by concerns for cost and access. Our experience at the University of Pittsburgh Medical Center leads us to believe that well-trained physician extenders will play a valuable role in improving efficiency and effectiveness in the care of critically ill patients. We have developed a method for training and supervision. Graded practice supervision, with physician-led professional review, is considered a reasonable goal. We propose that the appropriate degree of supervision in any given area can be determined by: a) careful development of training programs; b) careful assessment of the individual's practice with the target patient population; and c) application of a review process that is sensitive in that population. Issues surrounding the independent practice and reimbursement of acute care nurse practitioners (ACNPs) are not resolved. These issues should be addressed by joint position statements that are based on objective documentation of the safe, effective performance of ACNPs, and on the incorporation of routine performance measurements with continued medical or joint evaluation of the quality review system. Guidelines regarding the evolving roles of ACNPs should be established by professional associations and state or national boards of both nursing and medical practice. Critical care physician and nursing leaders should lead such initiatives.
在本世纪初，公众对医疗质量控制的关注促使对医生行医执照进行规范，如今，医疗保健领域的变革力量再次强大，这次是由对成本和可及性的担忧所驱动。我们在匹兹堡大学医学中心的经验使我们相信，训练有素的医生助理将在提高重症患者护理的效率和效果方面发挥重要作用。我们已经开发出一种培训和监督方法。分级实践监督，由医生主导专业评审，被视为一个合理目标。我们提议，在任何特定领域的适当监督程度可由以下因素确定：a）精心制定培训计划；b）仔细评估个人针对目标患者群体的实践；c）应用在该群体中敏感的评审流程。围绕急性护理执业护士（ACNP）独立执业和报销的问题尚未解决。这些问题应由联合立场声明来解决，声明应基于ACNP安全、有效表现的客观记录，以及纳入常规绩效衡量并持续进行医疗或联合质量评审系统评估。关于ACNP不断演变角色的指南应由专业协会以及护理和医疗实践的州或国家委员会制定。重症医学医生和护理领导者应引领此类举措。
