Could AP-Led Quality and Safety Grand Rounds Improve Patient Outcomes?

Grand rounds provide an opportunity for oncology advanced practitioners (APs) to discuss quality and safety across disciplines and may have positive effects on patient outcomes, according to research presented by Courtney Dryden, MPAS, PA-C, oncology AP quality and safety coordinator, and Angela Bazzell, DNP, APRN, FNP-BC, AOCNP, assistant director of APs, both at University of Texas (UT) Southwestern Medical Center’s Harold C. Simmons Comprehensive Cancer Center, during JADPRO Live Virtual 2021. This formal discussion group created a “new forum for oncology APs who were otherwise siloed within their own subspecialty,” the authors wrote.

Ms. Dryden and Ms. Bazzell identified a need for APs to gather to discuss managing adverse events (AEs), complications, and current practices. While APs provide a large proportion of oncologic care in the U.S., they have historically been underrepresented in quality and safety improvement initiatives. After conducting a PubMed search for AP-led grand rounds, Ms. Dryden found that only two other institutions had developed such a program, and neither focused on quality and safety.

To identify areas in which current processes led to “a near miss,” or potential for patient harm, the researchers conducted a review of safety events. They collected a list of relevant topics for discussion and created a virtual platform for the presentation of quarterly oncology AP quality and safety grand rounds in which APs could discuss impactful safety events, rare complications, and oncologic emergencies. The grand rounds were open to all APs at UT Southwestern regardless of subspecialty. The virtual format allowed a larger group of APs to attend during the COVID-19 pandemic, according to the researchers.

The first oncology AP quality and safety grand rounds presented in this study focused on spinal cord compression. A total of 112 APs across 26 subspecialties at UT Southwestern accepted the invitation to participate. Of those who accepted, 41 were in attendance, and 17 actively participated in a post-presentation discussion exploring process changes. The discussion inspired the creation of a new AP-led initiative for the rapid evaluation and management of patients with spinal cord compression aimed at improving morbidity and mortality. With input from various stakeholders in radiology, neurosurgery, and radiation oncology, this initiative ultimately led to the development and adoption of new spinal cord compression protocol across the institution.

“Oncology AP quality and safety grand rounds resulted in system-wide change, illustrating the importance of APs influencing overall health system approaches,” the researchers concluded.

Based on these results, Ms. Dryden and Ms. Bazzell suggested that “institutions should consider adapting similar models to encourage a collaborative approach to improve patient care.”


Dryden C and Bazzell A. Oncology advanced practice provider quality and safety grand rounds: Development, implementation, and improving patient outcomes. Clinical poster JL914. Presented at JADPRO Live Virtual, October 7-17, 2021.