Abstract
In the setting of physician shortages, nurse practitioner (NP) roles have evolved, with increasing independence across most healthcare settings. We sought to characterize referring clinician perceptions of NP-performed outpatient pediatric cardiology consultations. We electronically distributed to pediatric and family medicine physicians and NPs in Arkansas our 11-item survey assessing the acceptability of pediatric cardiology consultations being completed by an NP under varying circumstances. Circumstances included seven common referral indications, and the scale offered five answer choices ranging from “definitely unacceptable” to “definitely acceptable”. A total of 292 of 1756 (16.6% response rate) referring clinicians responded to the survey. Overall, 57% of responses indicated that NP-completed pediatric cardiology evaluations were either definitely or probably unacceptable. Acceptability was varied by referral indication and referring clinician characteristics. Unacceptability of NP-completed pediatric cardiology evaluations was greatest among family medicine physicians (81%), pediatricians (66%), and clinicians working in solo or two-physician practices (77%) or community hospitals/clinics (71%). If NP evaluation of a murmur included required review with a cardiologist, the unacceptability rate dropped from 50 to 24% (p < 0.0001). Unacceptability was higher in physicians who do not work with NPs (69%) compared to those who do (60%) (pp < 0.0001). Many referring physicians were willing to send patients ≥ 100 miles to ensure evaluation by a pediatric cardiologist. Most referring physicians find pediatric cardiology evaluations performed by NPs to be unacceptable. Requisite review with a cardiologist improved acceptability of NP evaluations. Many referring physicians would send patients much farther to guarantee evaluation by a cardiologist.
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Abbreviations
- NP:
-
Nurse practitioner
- EKG:
-
Electrocardiogram
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Acknowledgements
The authors of this study would like to acknowledge the Arkansas chapters of the American Academy of Pediatrics and the American Academy of Family Physicians for distributing this email-based survey.
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Dr. LS conceptualized and designed the study, designed the data collection instrument, collected data, carried out initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. JAD conceptualized and designed the study, designed the data collection instrument, carried out initial analyses, coordinated and supervised data collection, and reviewed and revised the manuscript. Dr. MSR conceptualized and designed the study, carried out initial analyses, and reviewed and revised the manuscript. Drs. EHB, BKE, RTC, and SP conceptualized and designed the study, and reviewed and revised the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.
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246_2022_2959_MOESM1_ESM.jpg
Supplementary file1 Supplemental Figure 1 Influence of clinician type on the acceptability of nurse practitioners seeing referrals to pediatric cardiology clinic for seven referral indications (JPG 1776 KB)
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Suh, L., Renno, M.S., Bolin, E.H. et al. Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners. Pediatr Cardiol 44, 34–43 (2023). https://doi.org/10.1007/s00246-022-02959-0
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DOI: https://doi.org/10.1007/s00246-022-02959-0