A Hybrid Heart Failure VAD Coordinator Model Decreases Burnout and Improves Work Quality of Life

Introduction The optimal structure of the multidisciplinary VAD team to optimize patient outcomes while maximizing provider satisfaction is unclear. The resource and time intensity of caring for VAD patients contributes to a high rate of burn-out and subsequent turnover, lowering overall job satisfaction and causing disruption in patient-care. Despite the proliferation of VAD programs, guidelines do not address this topic. We describe a hybrid model wherein HF nurse practitioners also function as VAD coordinators as an attempt to mitigate these challenges. Methods Starting in January 2020, The University of Florida Advanced HF Program reorganized its 6 advanced practice providers (APPs) to allow for 1 in-patient APP and 5 out-patient APPs. All APPs are trained in the care of acute and chronic HF, including advanced HF syndromes as well as in the management of VADs creating 6 HF/VAD Coordinators. The in-patient coordinator is actively involved in the care of HF and VAD patients admitted to the HF service while facilitating communication with the out-patient coordinators and arranging follow-up. The out-patient coordinators are assigned to specific HF Cardiologists, and along with HF and VAD office assistants, create a HF/VAD Care Team. The out-patient coordinators lead our post-implant VAD care, managing anticoagulation and blood pressure, while reviewing labs and imaging. Both HF and VAD patients have access to a HF/VAD Coordinator and this call is divided equally amongst all APPs. Regulatory and compliance assistance is provided by 5 HF/VAD assistants and 2 research assistants for INTERMACs data entry. After implementation of this model, APP burnout was assessed via the Copenhagen Burnout Inventory (CBI) and work satisfaction was assessed via the Work-Related Quality of Life Scale (WR-QOLS) and compared to results from a previously published national sample of VAD Coordinators. Results The CBI and WR-QOLS were completed by all 6 APPs. CBI demonstrated significantly lower levels of Personal Burnout (PB) and Work-Related Burnout (WRB) as well as a trend towards improvement in Client-Related Burnout (CRB) [PB 31.9 vs 54.1 p = 0.009, WRB 36.3 vs 53.0 p = 0.028, CRB 22.4 vs 36.0 p = 0.12]. WR-QOLS demonstrated a significantly higher Home-Work Interface (HWI) with trend towards higher General Well-Being (GWB) and Working Conditions (WCS) as well as lower Stress at Work (SAW) [HWI 4.4 vs 3.1 p = 0.003, GWB 4.2 vs 3.6 p = 0.086, WCS 4.3 vs 3.7 p = 0.079, SAW 3.4 vs 2.5 p = 0.051]. There was no difference in Job-Career Satisfaction (JCS) or Control at Work (CAW) [JCS 4.2 vs 3.7 p = 0.136, CAW 3.6 vs 3.6 p = 1]. Overall Quality of Work Life (OVL) was significantly higher [OVL 4.0 vs 3.3, p = 0.019]. Conclusions A hybrid HF-VAD coordinator model provides better work life quality and lower levels of burnout when compared to national benchmarks. Future investigation will explore how this hybrid approach affects patient satisfaction and continuity of care. These and forthcoming data may help to inform guidelines regarding optimal VAD coordinator staffing models.