Adam Betz MD, Daniel Hopkins MD, and Brooke Weaver APN, from Oklahoma Heart Institute in Tulsa, Oklahoma, discuss their innovative ICU program of advanced practice provider (APP)-driven Impella management and repositioning. Dr. Betz shares a patient case study highlighting how having APPs trained to help manage and reposition Impella reduces the amount of time that patients are exposed to complications associated with Impella malposition. “We’re able to respond at a whole different level of expediency that is truly clinically significant,” Dr. Hopkins emphasizes. Brooke Weaver explains how having this opportunity to provide patient care in a timely manner has really changed how she cares for patients in the CVICU. All three describe how they approached the credentialing committee to initiate the program as well as the program training, protocols and outcomes to date. They emphasize the importance of having a multidisciplinary core of champions when starting such a program and ensuring that APPs are familiar with echocardiography and the Impella platform.