Abstract
Significance & Background: An APP role was established throughout ambulatory oncology infusion centers to address the need for an on-site, dedicated provider to support infusion patients and serve as the primary rapid response provider for the center. The APP functions as the first-line provider for patients experiencing treatment-related symptoms and/or hypersensitivity reactions. Clinical responsibilities include chemotherapy/immunotherapy teaching, symptom management, and assessment and intervention of acute conditions. However, patient volumes and location services should be considered for appropriate APP staffing levels to deliver safe, quality care. Purpose: To develop a grading tool to address appropriate APP staffing within ambulatory oncology infusion. The increased clinical acuity of patient treatments, patient volumes, higher risk for hypersensitivity reactions, and acute rapid response conditions necessitate appropriate APP staffing to address acute issues in a safe, timely manner. Furthermore, special consideration for APP staffing is needed based on the types of services offered at designated ambulatory oncology centers that can influence the APP's coverage of rapid responses throughout the center. Interventions: Identified criteria were utilized to develop a staffing complexity grading tool to evaluate APP staffing needs throughout ambulatory oncology centers. The criteria included the number of provider teams and specialty practices, infusion chairs, services offered, and volume of visits within each location, which influenced the scope of responsibility of the APP in the infusion unit and supporting rapid response situations. Specific criteria led to the identification of three grades of APP staffing complexity. Results: Utilizing the complexity tool (See Table 1), the current APP staffing levels were reviewed at each location and assigned a complexity grading level between one through three. The use of the APP staffing complexity tool identified the need for an additional APP at one of the busier, larger ambulatory locations, in which APP staffing was graded at a complexity level of two. The development of this tool resulted in the approval of a new APP position at the identified location. Discussion: Appropriate APP staffing is crucial in ambulatory oncology centers to support infusion units and rapid response teams. The development of an APP staffing complexity tool was successful in establishing the appropriate staffing structure at one of the ambulatory oncology centers. Future initiatives include developing an APP staffing tool for other APP-led clinics as the growth of oncology programs continues within the health system's ambulatory/network locations.