Saint Louis University Hospital
Working with all appropriate members of the health care team ensures coordination of patient care through the development and use of patient care and practice standards. Ensures that desired patient outcomes are usually achieved and that variances from established parameters are evaluated and addressed as necessary.
Performs a wide variety of high-level patient care activities which may include completion of patient assessment and history and physical, First and second assisting during cardiac surgical procedures, development of plan to address physical and psychosocial needs, evaluation of critical path progress and update team as indicated, consult around discharge planning issues, and patient/family teaching and clinical resumes. The Physician Assistant is accountable for the clinical outcomes of an assigned caseload.
1) Performs expert assessments on preoperative and postoperative cardiac surgical patients in an effort to identify actual or potential illness which may impact the course of hospitalization.
A) Evaluates and provides appropriate follow up of all results from labs, x-rays, EKGs and other comparable non-invasive procedures
B) Initiates treatment of patients within scope of practice and collaborative agreement
C) Provide pre operative and post operative care for patients on the cardiac surgery service line
D) Consults with collaborating physicians
E) Removes chest tube
F) Removes epicardial pacing leads
G) Inserts radial arterial catheters
H) Participates in extubation
I) Manages intra-aortic balloon pump
J) Completes pre-op orders as written or per protocol
K) Appropriate antibiotic is ordered based on allergy history
L) Schedules pre and post-operative tests and procedures.
M) Schedules surgeries/procedures as needed
N) Participate in the development of Patient/Family education - assuring appropriate referrals
O) Report any concerns to an attending
2) As per the supervisory agreement, first and/or second assists cardiac surgical procedures and independently performs approved procedures
A) Retrieves vascular tissue and maintains competency in endoscopic vein harvesting retrieval methods
B) Maintains sterility during procedures
C) Meets the specific needs of the attending surgeon, supporting their individual technique to expedite the procedure
D) Supports Surgical Service initiatives regarding patient care, efficiency and quality/safety
3) Coordination and implementation of strategies to manage appropriate lengths of stay and resource utilization for cardiac surgery patients in multiple settings.
A) Formulates a plan of care for identified cardiac surgery patients in conjunction with the patient, family, other members of the health care team, payers, and community resources
B) Assesses needs, communicates the plan, evaluates effectiveness, and revises the plan as needed to reflect changing needs, outcome, age and developmental status
C) Maintains up-to-date information for the interdisciplinary team regarding resources that are available in the community and the health system for the patients and family
D) Participates in discharge planning while managing each patient's transition through the system and transfers accountability to the appropriate person or agency upon discharge
E) Completes daily assessment, consults with cardiac surgery team, and documents appropriately in progress notes
F) Completes discharge orders which are co-signed by the Medical Staff
G) Completes medical record and final dictations in a timely manner
H) Serves as an expert consultant and works with the interdisciplinary team to develop a plan of care, incorporating research and evidence based findings as indicated
4) Demonstrates leadership ability of advanced clinical practice in the hospital and the community
A) Maintains clinical knowledge through continuous learning
B) Provides clinical consultation on complex patients in care conference and discharge planning and other settings when indicated
C) Represents specialty on specific hospital or system teams
D) Involved with community as it is related to clinical specialty
E) Contributes to the education of students and co workers
F) Assists in the development and implementation of both research and Performance Improvement projects, working collaboratively with other health care team members to improve patient outcomes and resources allocation
G) Disseminates knowledge through publication and presentations
H) Utilizes medical, therapeutic and corrective measures to treat illness and improve the health status of patients
I) Jointly develops and maintains a supervisory practice agreement with physician with written protocols or guidelines for practice that are annually reviewed and updated as necessary. May hold delegated prescriptive authority from the collaborating physician
J) Contributes to discharge rounds and provides a communication link with care coordinator/ social work and the patient.
K) Performs additional responsibilities as identified
5) Collaborates with the multidiscipline team in the development, implementation, evaluation and revision of the clinical care and outcomes of specific patient populations.
A) Evaluates the quality and appropriateness of care being received.
B) Trends and evaluates patient outcomes on a continuous basis.
C) Identifies opportunities for improvement in care and/or outcomes.
6) Specialized Care: Provides specialized care to patients at high risk for injury.
A) Restraint Care
1. Initiates/evaluates alternatives to restraint prior to application.
2. Applies restraints consistent with the approved procedure.
3. Monitors and assesses patient’s response throughout the restraint period at the appropriate intervals.
4. Provides specified patient care (toileting, skin care, hydration, feeding, etc.) on a timely basis.
5. Provides consultation for peers to determine alternatives to restraints and 1:1 observation.
6. Documents restraint use and associated care thoroughly.
B) Pain Management
1. Assess patient for presence of pain on admission and during assessments/reassessments.
2. Incorporates patient’s cultural/spiritual beliefs regarding pain into pain management plan.
3. Implement pain management techniques. Focus on prevention rather than treatment.
4. Include patient and/or family members in developing a pain management plan.
5. Consider other methods of pain control when developing plan of care: massage, repositioning, immobilization, and music therapy.
C) Abuse Assessment
1. Is aware of abuse recognition criteria and incorporates it into assessments.
2. Reports signs of possible abuse/neglect to the physician, Risk Management and Social Work.
3. Takes appropriate action to support patient safety when signs of abuse are noted.
7) Demonstrates accountability for own professional practice.
A) Adheres to all quality and performance standards, policies, procedures, and protocols when implementing clinical and technical aspects of care.
1. Participates in learning experiences that increases professional competence.
B) Demonstrates appropriate technical and cognitive skills for area of practice.
C) Maintains currency in all hospital / unit information, communication, policies and procedures.
2. Reviews Hospital / Professional publications
3. Keeps up to date with policies and procedures
D) Demonstrates ability to change and adapt to changing work demands
1. Responds positively to change
2. Provides assistance and support to peers, co-workers and other team members
3. Adapts positively to changes in unplanned work load and job demands
8) Ability to relate to coworkers in a professional and appropriate manner.
A) Orients and/or precepts new employees when required.
B) Participates in and maintains a collaborative team approach toward work.
C) Functions as a resource person to co-workers, patients / families, medical staff and other members of the health care team.
D) Effectively assumes and delegates care and other activities to the appropriate team member.
E) Redirects clinical staff when the medical plan of care is altered.
F) Communicates the plan of care to be followed on each individual patient in a precise and professional manner.
G) Responsible for the supervision and teaching of students / new staff nurses.
9) Safety/Infection Control: Performs job in accordance with safety and infection control policies.
A) Practices standard precautions and disposes of hazardous wastes per established guidelines.
B) Maintains a safe, clean, comfortable, and therapeutic environment for patients / families / employees in accordance to hospital standards.
1. Maintains clutter free environment.
2. Keeps personal conversations/background noise to a minimum.
3. Adheres to dress code.
C) Reports risk management concerns using eSRM.
D) Assumes responsibility for completing all annual mandatory requirements:
- Bachelor’s Degree supplemented with 1 year related work experience. Graduate of an approved/accredited Physician Assistant program
- Current Missouri Physician Assistant Licensure. BLS and ACLS certification
- 1 year in a cardiac surgery fellowship or as a PA in a cardiac surgery program, Ability to retrieve vascular tissue and demonstrates competency in endoscopic vein harvesting retrieval methods
- Call required