(50) Assessing the Feasibility of an Inpatient Stem Cell Transplant (SCT) Continuity Advanced Practice Provider (APP) Role: A Pilot Project

Title: Assessing the Feasibility of an Inpatient Stem Cell Transplant (SCT) Continuity Advanced Practice Provider (APP) Role: A Pilot Project

Abstract : Pediatric stem cell transplant (SCT) patients are medically complex and prone to complications that can result in prolonged hospital stays and ICU admissions. Our SCT program designates some patients as "enhanced care" (EC) based on length of stay (LOS), readmissions, and ICU needs. EC patients receive systematic, psychosocial, and clinical support, but a dedicated inpatient continuity provider had not historically been considered. A literature review revealed limited data on Inpatient Continuity Advanced Practice Provider (ICA) models.

To address this gap, we introduced the ICA role to improve care coordination, communication, and timely interventions. The ICA serves as a consistent inpatient provider familiar with the patient’s evolving clinical status. This pilot project assessed the feasibility of implementing the ICA role and explored its potential benefits.

The ICA model was piloted in April 2024 on the inpatient pediatric SCT unit at a free-standing academic pediatric hospital. EC patients were identified based on complexity and LOS. An SCT APP with an established patient relationship volunteered for the ICA role. Responsibilities included longitudinal oversight, care coordination, and family communication. Evaluation included quantitative measures (ICU transfers, LOS, readmissions) and qualitative feedback from providers, nurses, and families.

To date, four ICA-patient pairings occurred. One patient died on day +162 post-SCT. Three patients survived to discharge; two required multiple readmissions, and all experienced ICU admissions. The ICA role was deemed feasible. ICAs described the role as meaningful and impactful. Providers reported improved communication and care coordination, while families appreciated having a dedicated provider, noting increased trust and enhanced communication.

Challenges included workforce sustainability and balancing ICA duties with inpatient responsibilities. Future plans involve continued evaluation, expanded patient inclusion, and a formal survey tool for staff and families. This pilot addresses learning gaps in advanced practice work models, professional practice, critical conversations, and psychosocial communication strategies.