December 13, 2017/Urology & Nephrology/Urology

Advanced Practice Providers Help Boost Efficiency for Institute Physicians, Expand Access for Patients

It’s a win-win when APPs manage their own patients


When Dana Longo, CNP, began her career as a nurse practitioner in 2012 at Cleveland Clinic, she stepped into a role where she supported a busy robotic surgeon. She worked alongside him in clinic seeing patients and managing administrative tasks — making patient phone calls, filing documents and performing other nonclinical duties.


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A few years later, Edmund Sabanegh Jr., MD, Chairman, Glickman Urological & Kidney Institute’s Department of Urology, realized that having advanced practice providers (APPs) — nurse practitioners and physician assistants — perform supportive roles represented underutilization of talented personnel and a lost opportunity. Instead, Dr. Sabanegh, also Cleveland Clinic’s Associate Chief of Staff, envisioned them practicing at the top of their licensure.

“It’s been a huge culture shift and transformation,” says Ms. Longo. Today, about 75 percent of institute APPs has some level of independent practice, treating patients for a range of nonsurgical concerns such as incontinence, kidney stones and urinary tract infections (UTI).

With a nationwide shortage of urologists, the shift to using APPs to the full extent of their licensure, has lowered costs and improved efficiency, notes James Ulchaker, MD, Vice Chairman, Department of Urology.

“Patient wait times have been drastically reduced,” he says. “For instance, if a patient has a UTI, they can often get same-day care accessed through our virtual visit UTI clinic or an in-person visit with an APP.” APPs are spread out geographically across various Cleveland Clinic sites to increase access.

Specialists and APPs remain in close contact

“If I need to contact one of the doctors, they’re happy to take the call,” Ms. Longo says. “I explain my management plan, we talk things through, and they agree or make suggestions.”

To begin the transition, the Urology Department analyzed results of an APP survey. It was clear APPs were eager and capable of taking on additional responsibility. However, many had been working in specialized clinics and needed more training in fundamental areas. So urologist Hadley Wood, MD, created an educational series of reading, assessment and didactic lectures on general urology. The American Urological Association has since accepted the curriculum she developed as the official online education program for the association’s nurse practitioner and physician assistant members.

Referring physicians appreciate their patients being seen more quickly, Ms. Longo adds, especially when a procedure such as a prostate biopsy has been ordered. Though they focus on nonsurgical care, the APPs do perform some simpler procedures, such as cystoscopy and ureteral stent removal following a kidney stone procedure. They may perform biopsies eventually, Dr. Ulchaker notes.

“We’re working to continue to increase the scope of practice of our APPs,” he continues, “which will help urologists maximize their time in the operative environment. This means surgical wait times are decreased and optimal quality of care is achieved.”


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