Surgical - Home Hospital Advanced Practice Provider (NP or PA)

The APP will primarily admit at Salem Hospital with flexibility to serve MGH and provide care to Home Hospital patients who live in the surrounding towns.

Job Title: Surgical Home Hospital Advanced Practice Provider

Reports To: Home Hospital Surgery Lead APP & Home Hospital Director of APPs & Clinical Director of Surgical Services

Full-time 36-40hrs

General Overview

The Surgical Home Hospital Advanced Practice Provider (HH APP) will be part of a clinical team that provides acute-level care to surgical (operative and non-operative) patients in the comfort of their own home. The MGB (Mass General Brigham) Home Hospital (HH) is an innovative strategic service line aiming to improve patient care by shifting it out of hospitals and into the home-based environment, increasing hospital capacity and reducing total costs of care.

The Surgical Home Hospital Advanced Practice Provider will support the work of the Surgical Home Hospital by evaluating (either in person or virtually) and managing patients in their home as a direct Surgical Home Hospital provider, supported by a multidisciplinary team that includes an Attending Surgeon (who oversees the direction of care for patients enrolled), a Home Hospital nurse, a paramedic (Mobile Integrated Health), an administrative coordinator, and other allied staff as needed (e.g. home health aide, physical therapist). The Surgical Home Hospital APP will work with the inpatient surgery teams at all five participating MGB Hospitals (MGH, BWH, Salem, Faulkner, NWH) to identify patients (both operative and non-operative) admitted to the hospital-based Surgery Service or in the Emergency Department who can be admitted to the Surgical Home Hospital service. The Surgical HH APP will screen for appropriate patients, communicate with the hospital-based Surgery teams about appropriate patients, consent patients for admission, and subsequently manage patients on the Surgical Home Hospital Service. These patients may be in the Emergency Department and deemed appropriate for direct admission to Surgical Home Hospital, admitted to the Surgery inpatient service and deemed appropriate for transfer to the Surgical HH Service &/or be elective surgery patients who in the pre-operative setting were identified as appropriate for transfer to HH in the postop setting.

Upon admission to the Surgical Home Hospital service, the Surgical HH APP will see the patient either in the brick & mortar hospital, in person in the patient's home or virtually. The Surgical HH APP will be responsible for placing admission or transfer orders to the Surgical HH Service. Daily Surgery HH rounds will consist of at least one daily patient encounter (in-person or virtual depending on patient needs and clinical course), with medical decision-making and delivery of needed care as appropriate (see specific clinical duties below). The Surgical HH APP will facilitate continuity between care settings, ensure home-based and acute care protocols are seamlessly integrated in the home settings, and function as the responding clinician in the home environment.

The ideal candidate for this Surgical HH APP role will be a patient-centered, proactive, flexible, experienced, and confident clinician comfortable with autonomy. Must collaborate well with multidisciplinary teams and able to make complex clinical decisions as well as be comfortable with level-of-care triaging, and telemedicine. The role offers the potential to broaden clinical duties as the Surgical HH Service expands. This may include involvement with the research & development team creating surgical HH pathways and protocols.

Principle Roles/Responsibilities:

* Provides acute-level care of surgical patients (both operative & non-operative) in the home setting (in-person and/or virtual) as a key member of the Surgery Home Hospital treatment team (including receiving the patient at his/her/their home, establishing a treatment plan, following Home Hospital protocols where appropriate, acting as a liaison between the home and other care settings, timely clinical documentation, and responding to patient needs with the ability to triage decisions around escalation of care). Other clinical duties may include facilitating in-home diagnostics, point-of-care testing, administration of medications and other treatments, remote patient monitoring, clinical documentation, drain management, wound management, interpretation of diagnostic imaging & laboratory data.

* Works with the Home Hospital Brick & Mortar team members (nurse navigators, coordinators) to identify appropriate Surgical patients for transfer/admission to the Surgery HH service and completes the admission process.

* Establishes relationships with the inpatient Surgical teams (APPs, surgical residents & surgeons) at all five MGB sites to help foster seamless transition of care to the Surgery HH Service line.

* Provides remote overnight backup call to the HH Nocturnist APPs for any surgical patients on the Surgery HH Service. Remote backup call would be one week/month.

* Collaborates with multidisciplinary Home Hospital team members and patients' longitudinal care team members around appropriate, safe, effective, equitable, and timely care delivery for Home Hospital patients. As well as daily collaboration w/ the Attending Surgeon of record to ensure closed loop communication about the plan of care.

* Communicates with the patient and family about Surgery HH, incorporating patient and family values and goals in the plan of care.

* Maintains a safe care environment for HH patients and leads in the practice of and reinforcement of a strong safety culture among all clinical partners involved.

* Attends relevant team and other meetings related to Home Hospital and related work.

* Participates with quality measurement and/or quality improvement initiatives, as appropriate, to advance the work of Home Hospital and other alternative care pathways, including advancements or innovations within the electronic health record.

Qualifications

* At least 5 years of Nurse Practitioner (NP) or Physician Assistant (PA) experience with a minimum of 2 years of Acute Care Surgery &/or General Surgery experience, preferably practicing in an acute hospital setting; academic medical center experience a plus.

* Current Massachusetts Licensure as a NP or PA with a Master's Degree required.

* MGB institutional knowledge a plus.

* Advanced Cardiac Life Support (ACLS) certification is required.

* Flexible and comfortable with a fast-paced, evolving clinical environment & autonomy.

* Motivated, collaborative team player who also works well independently.

* Creative problem solver with the ability to think innovatively.

* Excellent oral and written communication skills.

* Demonstrated knowledge of quality measurement and quality improvement.

* Track record of proficiency in managing relationships and building networks.

* Previous experience with Continuous Quality Improvement efforts and development of evidence-based protocols a plus.

Shift Requirements/Working Conditions

* Role is Full time, 36 to 40hrs, 12hr shifts 7A-7P, this includes rotation of weekends (no more than every 3^rd weekend) and rotation of major holidays

* Role will also include remote overnight backup call to the HH Nocturnist APPs for any surgical patients on the Surgery HH Service. Remote backup call would be one week/month.

Mass General Brigham Healthcare at Home, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender identity, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.