Real AF Practice Structure Survey

The purpose of this survey is:

1. To understand resourcing for EP programs across the REAL AF network as related to AF ablation volume and outcomes

2. To provide an evidence and outcomes based benchmark to support our investigators in resourcing their own programs

3. To understand how EP personnel and resources are utilized

If you have any questions or comments about the survey please email Dr. Amit Thosani (Amit.Thosani@ahn.org)

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1. Name

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2. Organization

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3. # of physicians performing AF ablation

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4. # of Nurse Practitioners

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5. # of PAs

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6. How are NPs utilized?

INPATIENT

OUTPATIENT

ASSIST WITH AF PROCEDURE (obtaining access, positioning catheters, etc)

CARDIOVERSION

LOOP RECORDER IMPLANTATION

INDEPENDENT NP LEAD AF CLINIC

Other (please specify)

Not Applicable

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7. How are PAs utilized?

INPATIENT

OUTPATIENT

ASSIST WITH AF PROCEDURE (obtaining access, positioning catheters, etc)

CARDIOVERSION

LOOP RECORDER IMPLANTATION

INDEPENDENT NP LEAD AF CLINIC

Other (please specify)

Not Applicable

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8. Do you have an outpatient practice manager?

Yes

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9. Is your (the physician) clinic day:

Full day

Half day

Other (please specify)

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10. How many days per week are the physicians in clinic?

Outpatient Clinic Structure (physician):

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11. # Of exam rooms per physician

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12. # of outpatient nurses per clinic day per physician

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13. # of outpatient medical assistants per clinic day per physician

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14. # of staff performing preauthorizations per clinic day per physician

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15. # of administrative/executive assistants per clinic day per physician

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16. # New patients seen by physician in half day of clinic:

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17. # Returning patients seen by physician in half day of clinic:

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18. How much time is given for new patients (in minutes)

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19. How much time is given to returning patients (in minutes)

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20. Who performs primary documentation? Check all that apply:

Scribe

Fellow

Medical Student

Other (please specify)

Outpatient Clinic Structure (NP/PA lead clinics)

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21. # Of exam rooms per clinician

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22. # of outpatient nurses per clinic day per clinician

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23. # of outpatient medical assistants per clinic day per clinician

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24. # of staff performing preauthorizations per clinic day per clinician

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25. # of administrative/executive assistants per clinic day per clinician

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26. # New patients seen by a PA/NP in half day of clinic:

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27. # Returning patients seen by PA/NP in half day of clinic:

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28. Do NPs/PAs see the following:

established patients

new patients

Some procedure follow-up intervals

All procedure follow-up intervals

Other (please specify)

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29. Do you have outreach clinics?

Yes

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30. Who does outreach clinic? Check all that apply.

Other (please specify)

Not Applicable

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31. # of outpatient scheduling staff

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32. Additional key staff? Check all that apply.

Clinical managers

Nurse navigator

Other (please specify)

None of the above

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33. How do you consent patients for procedures? Check all that apply

Discussion in clinic

Signature of consent form prior to day of procedure

Signature of consent form on day of procedure

Multi-level consent process

Other (please specify)

Device Clinic Structure

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34. # of device clinic nurses

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35. # of device clinic technicians

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36. # of device clinic NP/Pas

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37. Do you use any software?

Yes

33% of survey complete.