P91: ECMO Education Initiative for Advanced Practice Providers.

Study: Our Adult ECMO program is supported by a rounding model where an ECMO Specialist is in house 24/7 and available to be called for bedside support. We are able to utilize this rounding model due to the high level of expertise from our multidisciplinary critical care teams. This expertise is maintained through a robust nursing competency program, as well as a credentialing process and accredited continuing medical education (CME) course for physicians. However, a gap in initial and ongoing competency was identified for Advanced Practice Providers (APP). Prior to 2021, a total of 19 APPs had received some form of initial ECMO education with no ongoing recompetency training. Our APPs serve as frontline providers and first responders in ECMO emergencies. Therefore, we aimed to develop an education program, including didactic and hands-on training, which provides them with necessary competencies in managing patients on ECMO support. Methods: Our team introduced the APP Adult ECMO Education Initiative in April 2021. The initiation of this program included the development of the Education & Training Policy for Multidisciplinary Critical Care Team, a policy outlining the educational requirements for RNs and APPs who care for patients requiring ECMO, the creation of the Adult ECMO APP Emergency In-Service and the creation of the Adult ECMO APP Initial Training Course. Additionally, our existing Adult ECMO Management CME Course was adjusted to better meet the competency needs of both APPs and physicians managing ECMO patients. Post-initiative, three institutional ECMO education options were available to APPs (Figure 1). Additionally, the newly created policy mandated initial and annual competency training for any APP who cares for a patient on ECMO. Results: 25 APPs attended at least one of our institution’s three ECMO education courses in Fiscal Year (FY) 2021, 33 APPs in FY 2022 and 31 APPs in FY 2023 (as of January 2023). This is compared to 15 or less in previous fiscal years (Figure 2). Post-test scores for our CME Course consistently show an increase in knowledge with an average score increase of 25 points, compared to the pre-test score, in the last three course offerings. For FY 2022, our ECMO survival rates included an 84% survival of ECMO with a 75% survival to discharge, compared to 78% survival of ECMO and 70% survival to discharge in FY 2021. In FY 2022, 54% of patients had zero ELSO-defined complications, compared to 47% in FY 2021 and 38% in FY 2020. Summary: Development and implementation of a structured training program for APPs has enabled our ECMO Program to improve upon our high-quality care by increasing APP’s proficiency in ECMO management.