Advanced Practice Provider - (PA/NP) Pulmonary Critical Care/ Lung Cancer Screening - Florence Medical Center

Fair Labor Standards Act Status: Salaried

Hours per week: 40

Scheduled Work Hours/Shift: M-F 8A-5P

Patient Population focus:
Inpatient, Outpatient, Procedural Unit, Infusion Suite, Emergency Department Management/Consultation.

Patient Population Age Range:
18 years-death

Required Minimum Training and Education:
Completion of an accredited Physician Assistant program and currently licensed or eligible for licensure as a Physician Assistant or completion of an accredited Nurse Practitioner Program and currently licensed or eligible as an AGACNP/ACNP

AGACNP/ACNP (Adult Gerontology Acute Care NP/Acute Care Nurse Practitioner): Adult pts (18 years to death), acutely ill or injured, potentially unstable, or technologically dependent (vents, drips, monitors, etc.)

Minimum of 1 year as a Physician Assistant or ACNP preferred.

Degree of Supervision
AGACNP/ACNP or Physician Assistant will be assigned a Primary Supervising/Collaborating Physician employed by MUSC and will report directly to this physician.

Required Licensure, Certifications, Registrations

Currently licensed (or eligible) in the state of South Carolina as a Physician Assistant by the South Carolina Board of Medical Examiners or as an AGACNP/ACNP with the SC Board of Nursing. Requires certification in Basic Life Support (BLS). If BLS is not current, provider must enroll and have received certificate by start date. Required certification in Advanced Cardiovascular Life Support (ACLS). If ACLS is not current, provider must enroll and have received certificate by start date. DHEC and DEA license applications must be submitted prior to first day.

Routine Duties

• Collaborate with the client/family to establish physical, mental, cultural and environmental factors that facilitate or impede realistic goals and activities.
• Conduct and document findings on initial, periodic, episodic, and/or annual health histories and physical examinations on patients seen in the clinical setting.
• Determine potential needs for therapeutic changes, diagnostic workups or subspecialty consultation and so order.
• Order and/or interpret appropriate laboratory tests, x-rays and chest imaging, EKG’s, pulmonary function testing and report of other diagnostic studies and procedures.
• Provide follow-up for evaluation of outcomes of x-rays and chest imaging, laboratory tests and diagnostic procedures. Detect and evaluate any significant change in patient’s condition, treating as indicated with current evidence-based practice.
• Review medications for clinical need, simplification and possible drug-drug interactions and adjust as indicated.
• Prescribe, administer and review/evaluate patient’s response to pharmacological and non-pharmacological treatment excluding narcotics and controlled medications.
• Evaluate outpatients and manage acute and chronic illnesses according to the usual scoped of care to include attention to maintenance of stable conditions, preventive health care and screening.
• Formulate diagnostic plans and therapeutic regimen, including possible hospitalizations.
• Make referrals to and collaborate with home health services to provide and maintain continuity of care.
• Plan, provide and evaluate care that promotes wellness and prevents disease/injury and disability.
• Assist patient to maintain or improve their current state of health when disability already exists.
• Assist patients to regain or improve their abilities to cope with states of health and illness.
• Provide education and counseling of the patient and the patient’s family in preventive care, medical conditions and the use of prescribed treatments and drugs. Maintain phone contact with patients, families and home care agencies as indicated.
• Facilitate follow-up referrals to smoking cessation care.
• Organize and lead in-services to educate and share information about the lung screening with clinical staff
• Optimize patient-centered care practices through patient education, care management and appropriate utilization of system processes.
• Ongoing monitoring and scheduling of patient screening exams, procedures, clinic appointments; monitors and assist with follow-up of abnormal findings.
• Accountable for following study protocols and documentation of study data points; lead the collection and submission of project data from a variety of sources.
• Provide reports to CMS for accreditation.
• Assumes primary patient care responsibility for patients in the Lung Screening and Nodule Program under the supervision of the Co-Director of the Program.
• Participates in all activities relating to the Lung Cancer Screening and Nodule Program, including education, development of patient educational materials, continuing quality and safety initiatives, continuing medical education programs, direct patient care, and other activities relating to the Lung Cancer Screening and Nodule Program and Thoracic oncology as defined by the Co-Directors.
• Identifies health care needs and assesses health status of patient/family during outpatient encounters, including initial evaluation and subsequent outpatient care follow-up, as well as inpatient hospitalization if appropriate. Monitors patients across the health care continuum and develops strategies to maximize compliance with recommended interventions.
• Prescreens patients for appropriateness of lung cancer screening and discusses rationale and options with patients providing balanced information on the risks and benefits of lung cancer screening as well as individualize risk calculation. Obtains comprehensive health complete histories and performs complete physical exams during initial evaluation as well as subsequent follow up. Documents all encounters in medical record.
• Identifies and collaborates with the specialty interdisciplinary team in the design of patient treatment plans.
• Communicates patient status information, attends outpatient clinics, attends Tumor Board and other educational and administrative meetings related to the Lung Cancer Screening and Nodule Program and Thoracic Oncology, and appropriately documents progress in the Medical Record.
• Enters diagnostic imaging and laboratory orders, orders appropriate tests and therapy; interprets results and outcomes; discusses appropriate plan and interventions with the physicians.
• Supports the research mission through collaboration with investigators and protocol personnel and enrolls and manages study participants on lung screening and related research studies.

Shared Decision-Making Visit for new referrals and annual follow-up

• For new patients that do not show and unable to reach by phone x 2 to reschedule, send letter to patient and referring provider (if applicable)
• For annual patients that do not show and unable to reach by phone x 2 to reschedule, send letter
• Prior to seeing patients for both new and annual visits, perform chart review to ensure it has been at least 1 year since last chest imaging and review whether any competing causes of death would prohibit them from starting or continuing annual screening

Screen Detected Lung Nodules

• LungRads 3 and higher reviewed in Thoracic Tumor Board; this is for screens done within the LCS program as well as those being managed outside of the program (example: LDCT ordered by PCP, nodule detected and noted when reviewing cases within Eon Direct Database)
• Ensuring patients are scheduled for appropriate follow-up/referrals
  • If unable to reach patient by phone x 2 attempts, send certified letter

Incidental Findings

• Non-urgent incidental findings should be communicated to both the patient and primary care provider to determine appropriate evaluation
• Urgent incidental findings: work-up started by APP but referrals placed to appropriate specialist to take over management

American College of Radiology

• Using Eon Direct, review all CT lung cancer screening to ensure information is accurate and submit to ACR

Assist in Lung Nodule Clinic

• Evaluate patients with the pulmonologists
• Ensure appropriate follow-up testing is scheduled
• Follow-up on biopsy results

Provide Tobacco Treatment

• Counseling and medication management; should be readdressed at each visit

Community Outreach and Marketing

• Meet with local primary care providers to educate about lung cancer screening and benefits of referring to a centralized lung cancer screening program
• Assist with marketing campaigns- radio, newspaper, social media, etc

Emergency Duties

Treat respiratory distress and/or emergent conditions in the absence of a physician or until a physician arrives. Initiate basic life support/First Aid to the extent that training supports following current AHA guidelines. Maintain current BLS certificate.

Assists in Tobacco Treatment as part of the Lung Screening Program

Will work with Co-Director Benjamin Toll, PhD to become a tobacco treatment counselor. Will counsel and educate current smokers on the benefits of smoking cessation. Will provide tobacco treatment prescriptions (e.g., nicotine replacement, bupropion, varenicline) to eligible patients.

Works as part of the pulmonary critical care team in the pulmonary clinic

Co-manage patients across the spectrum of pulmonary disorders including asthma, COPD, sarcoidosis, pulmonary fibrosis, lung cancer etc Respond to patient concerns in office and/or in between visits Order and follow up on labs, imaging tests, and other testing as indicated Order and interpret six-minute walk tests Order and interpret office spirometry and pulmonary function testing

Result: A lung cancer screening program which focuses on screening appropriate patients, adherence to annual screening, interval lung nodule follow-up, and tobacco treatment.

Goal: To have an Advanced Practice Provider who provides lung cancer screening and tobacco treatment within national guidelines and recommendations.