JoLynn Shinsako, PA-C, MS, physician assistant in transplant surgery at the University of Colorado Department of Surgery, helped found and currently leads a nocturnal advanced practice provider surgical subspecialty service aimed at optimizing patient care overnight in various surgical subspecialties.
In the recent past, overnight post-surgical care was provided by first-year residents, known as interns. These interns rotate specialties frequently, sometimes as often as every month during their first year of training.
“It wasn’t a mutually beneficial relationship for anyone,” Shinsako says.
In 2021, the CU Department of Surgery decided to reduce the number of preliminary interns hired. Rather than asking current residents or other departments to absorb the work previously done by these interns, they opted to create an advanced practice provider (APP) surgical subspecialty service.
APPs, such as nurse practitioners or physician assistants, are trained to perform medical activities similar to those performed by physicians. They hold advanced degrees and play an integral role in the care of patients in a variety of settings.
Shinsako was first hired in 2019 to provide overnight service to transplant patients. In 2021, she was tasked with helping to create a new service called the Nocturnal Surgical Subspecialty Service to care for cardiac, thoracic, vascular, burn, urology, and plastic surgery patients.
“It was exciting, as I was given an opportunity to reshape the way that we cared for patients at night using an active care model instead of a cross-coverage model,” she says.
Expanding overnight care
The program’s goal was to ensure continuity of care across various specialties. Over two years, Shinsako helped recruit and train a team of 11 APPs.
During this time, she also helped develop a comprehensive metrics dashboard to measure effectiveness. It tracks key performance indicators such as admissions, consults, and adherence to quality protocols. The dashboard comprises operational metrics, quality initiatives, and feedback on perceptions of safety and care quality.
"We wanted to measure our impact objectively," Shinsako says. "Our metric dashboard allowed us to see not only the numbers but also the real impact on patient care."
The APP team handles a range of responsibilities, from triaging patient issues to performing procedures and facilitating transfers when necessary.
The dashboard revealed a difference between the perceived and actual workload of caring for these complex surgical patients overnight. Though the workload for APPs is higher than initially estimated, Shinsako says the data from the interns was gathered during the pandemic, when fewer surgeries were occurring overall. In addition, each specialty grows, year after year.
Managing major change
Shinsako says that despite this new service being a major change for the organization, it’s been well-received. But it’s taken time.
“When asking for a huge organization to make a massive change, it’s expected to elicit pushback,” she says, explaining how it has taken two years to hire the full team. “It has required a lot more communication than I expected, but for the most part everyone has been really receptive and supportive.”
Overall, Shinsako believes the work and utility of the APP overnight program in a large academic setting is of value for both patient care and education.
"The attending physicians and nurses have been incredible supporters of our program," Shinsako says. "They've recognized the dedication and expertise that our APPs bring to caring for complex surgical patients overnight. They've seen how efficiently we triage and manage complicated situations and ensure the best possible care for our patients."
