Learn how the creation of the first advanced practice radiation therapist (APRT) role in the United States established a new model of inpatient care, elevating the radiation therapy skill set and allowing for intervention at key points along the radiation oncology care pathway.
This blog post is the fifth in a 6-part series highlighting the achievements of the 2023 ACCC Innovator Award winners before their in-depth sessions at the ACCC 40th National Oncology Conference. You can learn more about the innovations being recognized this year and those who pioneered them by joining ACCC in Austin, Texas, from October 4-6, 2023.
Innovations are characterized by the establishment of a novel, revolutionary or lifechanging idea. They are responsible for driving change and improvements in cancer care. By creating the first advanced practice radiation therapist (APRT) role in the United States, Mount Sinai Health System, Department of Radiation Oncology has led the way through elevating the Radiation Therapist to provide a new model of care.
The program was fully implemented in October 2022, but planning discussions began several years prior. According to Kimberly Smith, MPA, FACHE, vice president of Radiation Oncology Services at The Mount Sinai Health System, while the COVID-19 pandemic prevented the program from launching sooner, it also gave their team more time to flesh out the details. “It [COVID-19] gave us time to build our network, work with our international colleagues more and understand successful international models of Advanced Practice Radiation Therapy," said Samantha Skubish MS, RT(R)(T), ARRT, chief technical director at Mount Sinai Health System, Department of Radiation Oncology. “In hindsight, being able to get back to developing this program after COVID with a broader perspective was helpful.”
On a broad scale, Advanced Practice Radiation Therapy creates professional advancement opportunities for radiation therapists who have a higher-level technical and clinical skillset through elevated leadership—with education as a foundation. “When you provide new clinical advancement opportunities for radiation therapists, you can create a better model of care, reduce inefficiencies, and address certain issues individual departments may have,” Skubish explained. According to Skubish the anticipated physician shortage among US radiation oncology departments will place a greater level of burden on physicians. However, she believes that, the APRT can mitigate the effects of this workforce shortage and reduce physician burnout by task-shifting and assuming lower-level responsibilities that support the care of resource intensive patient populations. Smith echoed her sentiment by stating, “We were focused on how we could reduce workflow inefficiencies, reduce clinician burnout increase staff retention and decrease administrative waste.” Achieving those goals remains the center piece of their innovation.
An already key member of the team, their assistant chief for Radiation Therapy, completed a master's degree in advanced clinical practice internationally and worked under the mentorship of the radiation oncologists in the department gaining the skills and knowledge of an Advanced Practitioner. According to Skubish, it “takes a village” to bring programs like this to life, and the collaboration of the cancer program's team of radiation therapists, educators, physicians, and leadership working together through their respective domains of expertise, was integral to effectively establishing the model. This included receiving grant funding from the American Society of Radiologic Technologists to study the APRT model’s effectiveness with support from their radiation therapy educators and researchers. “Radiation therapists in the US are not known to lead their own grant funded research initiatives, so this has been unique and a real hallmark of our success,” she said.
Smith and Skubish wager that the most important part of implementing the APRT role was clearly defining what responsibilities it would oversee. “We talked with several physician leaders within the department to make sure the APRT role was going to be acceptable, and to clearly delineate job responsibilities,” Smith explained. “In June 2022, I began the process of presenting the business model and justification for the position to the senior leaders of Mount Sinai.” By July 2022, senior leadership at Mount Sinai approved the APRT position, after which the job description and formal job code were developed. “By the end of that summer the APRT position was created and validated, and in September 2022, the first APRT was hired into the position,” Smith said.
According to Skubish and Smith, the program has improved quality, efficiency, time, and cost savings toward value-based care. “I sit on different committees, and listening to what the care providers have to say, there is a great deal of physician fatigue,” Smith said. “Several physicians within our department have said that the implementation of this program has been immensely helpful to them and has provided enormous value. To me that speaks volumes.”
At the ACCC 40th National Oncology Conference this fall, Skubish and Smith will provide an in-depth analysis on how to implement an advanced practice radiation therapist at your cancer program or practice. “I think this conference provides a great opportunity to collaborate with your colleagues, become motivated and inspired to think about innovative options for your own organization,” Smith said. To learn more about implementing an advanced practice radiation therapist at your organization, including the framework and support staff needed to find success, register to attend the 2023 ACCC National Oncology Conference in Austin, Texas, from October 4-6, 2023.
Understanding both the benefits to be had from offering BsAb therapy to its community and the scope of this undertaking, Vanderbilt-Ingram Cancer Center took a novel approach with its APP-led BsAb step-up dosing clinic, which won the program a 2026 ACCC Innovator Award.
