title: Optimal utilization of a breast care advanced practice clinician.
abstract: BACKGROUND
  Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team.
  
  
  METHODS
  An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction.
  
  
  RESULTS
  During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development.
  
  
  CONCLUSIONS
  Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care.
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Katie W
authors.initials: KW
authors.lastname: Russell
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mone
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Serpico
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Cori
authors.initials: C
authors.lastname: Ward
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Neumayer
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA. Electronic address: edward.nelson@hsc.utah.edu.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Nelson
mesh_terms: D000553:Ambulatory Care; D001071:Appointments and Schedules; D001941:Breast Diseases / Q000451:nursing* / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility; D017722:Hospital Charges; D006801:Humans; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009936:Organizational Innovation; D017060:Patient Satisfaction; D058996:Quality Improvement
keywords: Advanced practice clinician; Improved utilization; Independent breast care clinic; Lean principles; Nurse practitioner; Physician assistant