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The Critical Care Physician Assistant is a licensed physician assistant who possesses the advanced education, knowledge, clinical skills and experience necessary to provide expert advanced practice in critical care.  The primary responsibility of the Critical Care Physician Assistant (CCPA) is providing and directing care for patients in the adult ICUs at the UCSF Medical Center.  The CCPA is responsible for maintaining quality of care standards for all procedures and clinical care provided in the ICUs.  The CCPA provides self-direction and accountability in the development of this role within the medical center.

The CCPA shall provide medical care under the supervision of the Physician Director of Adult Critical Care Medicine and their individual collaborating physicians. The CCPA shall provide care in accordance with standardized procedures. The CCPA shall be proficient in the areas of arterial catheter insertion, central venous catheter insertion, ventilator management, sedation, and pain control.  The Medical Staff Office on a biannual basis grants privileges to practice at UCSF Medical Center.

The CCPA may rotate through all of the focused care ICUs at the medical center including: cardiothoracic, neurologic, neurosurgical, medical, general surgical, and transplant.  The CCPA shall work collaboratively with physician students, residents, fellows, and attending physicians. The CCPA will participate in the precepting of APP students and post graduate fellows. This position is scheduled for 12 hour rotating shifts from days to nights including holidays and weekends.
 

The Critical Care Advanced Practice Provider (CC APP) team at UCSF provides expert care in the adult intensive care units at UCSF Health. The CC APPs are an element of the interdisciplinary critical care team that includes attending physicians, physicians in training, pharmacists, registered nurses, rehabilitation therapists, and UCSF students. The CC APPs provide care in all of the adult intensive care units including Cardiac, Neurologic, Medical, and Surgical intensive care units. These units provide care for patients undergoing cardiac surgery, organ transplantation, thoracic surgery, orthopedic surgery, neurosurgical surgery, general surgery, or patients requiring complex medical management.The CC APP team collaborates with the UCSF School of Nursing and supports the UCSF Surgical and Critical Care Advanced Practice Provider Fellowship. The CC APP group is active in various quality improvement, cost reduction, and professional development projects.

Required Qualifications:

Graduation from a PA Program accredited by the Accreditation Review Commission on Education for the PA (ARC-PA).

• A minimum of one year of PA experience in adult critical care medicine or completion of an accredited APP fellowship incorporating critical care.

Preferred Qualifications:

• Completion of an accredited critical care practice transition program 
•  A minimum of 2 years of recent experience as an inpatient Physician Assistant in an academic medical center
   

License/Certifications:

1. California Physician Assistant (PA) License without restriction

2.  National Board Certification from the National Commission on Certification of Physician Assistants (NCCPA)

3. California Driver License (if required for position)

4. Drug Enforcement Administration (DEA) Registration with Schedules 2, 2N, 3, 3N, 4, and 5 registered to a California address

5. American Heart Association (AHA) Basic Life Support (BLS) certification

6. Additional required AHA certifications: ACLS

7. Additional required certifications: ENLS

 

Function

% of time

Duties

Inpatient - Direct Patient Care (may include some or all of the responsibilities listed)

60

1. Independently (independent APP encounter) or collaboratively (shared physician and APP encounter) evaluates and manages patients.

2. Includes taking histories, performing physical examinations, responding to changes in patient status, performing consults, ordering or furnishing medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.

3. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.

4. Provider services must be billed to reflect the performing provider and comply with the  APP Billing Policy 3.08.01.

5. APPs must respond to clinical documentation integrity inquiries from the Department of Quality and Patient Safety within 3 days.

1.2. Performs procedures granted to them via privileges/standardized procedures.

1.3. Identifies patients with acute decompensation or failure and responds to the hospital plan of care and reviews with physician.

1.4. Initiates consultations as indicated.

1.5. Documents independent assessment findings and recommends appropriate treatments.

1.6. Participates in service rounds and patient evaluation and treatment planning.  

1.7. Reviews lab tests, x-rays, and other diagnostic tests, and initiates appropriate team plans.

1.8. Evaluates complex cases, establishes individualized plans of care for disposition to a lower level of care.

1.9. Interprets and acts upon completed tests, procedures, and radiographic studies.

1.10. Completes clinically relevant paperwork/electronic health record (EHR) documentation, including but not limited to ordering medications, completing episodic care notes and discharge summaries in accordance with the UCSF Rules and Regulations.

1.11. Effectively communicates findings, treatment options, and care plans with patients and their families 

1.12. May first assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.13. Monitors and evaluates patients for discharge. Sets parameters and guidelines for continuum of care with multi-disciplinary team. This includes evaluating and defining discharge regimen.

1.14. Discharges patients including prescribing/furnishing medications, ordering DME, and recommending or referring for ongoing follow up care, providing discharge teaching, and completing discharge summaries.

Inpatient - Care Coordination (may include some or all of the responsibilities listed)

40

1.1. Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning.
1.2. Coordinates episodic care and determines timing of routine clinic follow up.
1.3. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.
1.4. Consults with nursing staff on plan and implementation of individualized nursing care plans. 

1.5. Independently provides case summaries for disability, insurance agencies, workers compensation, work releases, and medical supply agencies.
1.6. Formulates and implements protocols to improve quality and efficiency and control waste in the clinical specialty.

Outpatient - Independent Encounters (may include some or all of the responsibilities listed)

##

1. Evaluates and manages patients in independent APP encounters, including telehealth.

2. Includes providing care to new, follow-up, acute, routine, and specialty patients.

3. Includes taking histories, performing physical examinations, interpreting diagnostic tests, formulating evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.

4. Reviews or collaborates with attending physician as needed.

5. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.

6. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.

1.2. Performs procedures individually granted to them via standardized procedures/privileges.
1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate. 

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.
1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

Outpatient - Shared Encounters with Physician(s) (may include some or all of the responsibilities listed)

##

1. Evaluates and manages patients in shared encounters with attending physician, including telehealth.

2. This should increase clinic access with a goal of doubling clinic volume since two providers will be sharing the clinic responsibilities.

3. Includes providing care to new, follow-up, acute, routine, and specialty patients.

4. Includes taking histories, performing physical examinations, interpreting diagnostic tests, collaborating on evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.

5. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations

6. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.

   1. May first-assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate. 

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.
1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

Outpatient - Care Coordination (may include some or all of the responsibilities listed)

##

1.1. Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning. DOES not include management of inpatients.
1.2. Management of the EHR, including patient and staff messages and other inbasket tasks.

1.3. Coordinates episodic care and determines timing of routine clinic follow up.
1.4. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.
1.5. Attends department quality improvement meetings and participates in patient evaluation and planning.

1.6. Consults with nursing staff on plan and implementation of individualized nursing care plans. 

1.7. Independently provides case summaries for disability, insurance agencies, workers compensation, work releases, and medical supply agencies.

Total

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