APP Nocturnist - Home Hospital Per Diem

General Overview:

The Home Hospital Advanced Practice Provider (HH APP) will be part of a clinical team that provides acute-level care to 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 Nocturnist Home Hospital Advanced Practice Provider will support the work of Home Hospital by acting as the responding clinician for admitted HH patients on service, splitting the coverage with another Nocturnist APP. This may require scheduled or unscheduled virtual visits with the patient. The HH Nocturnist APP will respond to any clinical alarms for the remote monitoring system for HH patients, including facilitating virtual visits, assessing clinical situations, and intervening as deemed appropriate. The HH Nocturnist APP should be able to make clinical assessments, decision-making and clinical interventions with limited collaborating physician support. The HH Nocturnist APP will also be responsible for screening the MGB brick & mortar hospitals inpatient and emergency department lists for clinically appropriate patients for admission to the HH service the following day.

The ideal candidate for this HH APP role will be a patient-centered, proactive, flexible, and confident clinician comfortable with autonomy, complex clinical decision-making, level-of-care triaging, and telemedicine.

Principle Roles/Responsibilities:

• Provides acute-level care virtually in the home setting as a key member of the Home Hospital treatment team cross covering for all admitted HH patients. This includes completing the HH admission process, establishing a treatment plan, following Home Hospital protocols where appropriate, liaising 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.

• Responds to patient clinical alarms for the 24hr remote monitoring system.

• Other clinical duties may include facilitating in-home diagnostics, point-of-care testing, administration of medications and other treatments, patient monitoring, clinical documentation, and other patient needs as they arise.

• Screen all MGB brick & mortar institutions (BWH, MGH, NWH, BWFH and SLM) for patients that meet clinical appropriateness for admission or transfer to HH the following day. May participate in overnight remote admissions/transfers to HH and handoff to the Home Hospital daily rounding teams.

• Review and discuss w/ Brick & Mortar clinicians any HH consultations for patient transfer to HH.

• Collaborates with multidisciplinary Home Hospital team members on the Nocturnist team including HH Charge RN, HH Medics, Nocturnist APP Colleague, remote monitoring system RNs and MAs to provide appropriate, safe, effective, equitable, and timely care delivery for Home Hospital patients.

• Communicates with the patient and family about 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.

• 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 3 years of Nurse Practitioner (NP) or Physician Assistant (PA) experience practicing in an acute hospital setting; academic medical center experience a plus.

• Current Massachusetts Licensure as a NP or PA with a Masters Degree required.

• MGB institutional knowledge a plus.

• Proficient with EPIC EMR system a plus.

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

• Flexible and comfortable with a fast-paced, evolving clinical environment.

• 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 a nighttime position 7PM-7AM EST for per diem role, NOT an on-call role

• Minimum of 6 shifts/12-week block to fulfill per diem requirement

• This role is fully remote - the Nocturnist APP does not need to live in Massachusetts but must live within the following states (MA NH, VT, CT, RI)

• The role requires reliable internet and dedicated workspace for the full overnight shift