1
|
King NMA, Habeeb M, Helps S. The contribution of physician associates or assistants to the emergency department: A systematic scoping review. J Am Coll Emerg Physicians Open 2023; 4:e12989. [PMID: 37360223 PMCID: PMC10288079 DOI: 10.1002/emp2.12989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background New health care professionals, such as the physician associate or assistant (PA), have expanded the ability of health systems to meet the needs of the population in both primary and secondary health care settings. Although PAs are widely deployed in the emergency department (ED), their role in the ED has not previously been formally described. This systematic scoping review synthesizes and critically analyzes existing literature on the impact and perception of the role of PAs working in the ED. Methods We performed a systematic scoping review. We searched Medline, PubMed, Scopus, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE) and EMCare for English language peer-reviewed studies describing PA roles in the ED. Both qualitative and quantitative studies were included. We assessed the quality of the articles using QualSyst and the mixed methods appraisal tool. Themes regarding PA roles in the ED were identified. Results We included a total of 31 studies. Themes identified in the review included perceptions of the PA, wait times, acuity of patients seen, length of stay, those leaving without being seen (LWBS), clinical outcomes, pre-admission rates, well-being and scope of practice. Both the doctors' and patients' perception of PAs in the ED were generally high. The hindrance of them not being able to prescribe was evident. Studies showed a reduction in waiting times, length of stay, readmission rates, and those leaving without being seen when PAs work in the ED seeing moderate- to low-acuity patients. Evidence shows that PAs have a positive impact and the perceptions of the PAs are high in international EDs. There is significant evidence of PAs being key members of the health care team. Their work is particularly helpful for low- to moderate-acuity patients. With the increase in health care demand and a suffering UK National Health Service (NHS), the evidence synthesized in this review supports the potential positive impact PAs can have on the NHS and more specifically, the improvements of ED throughput metrics. Conclusions This review identified the roles and positive influence of PAs in the ED. These findings highlight current and future challenges for PAs in the ED.
Collapse
|
2
|
A curriculum to improve knowledge and skills of nurse practitioners and physician assistants in the pediatric emergency department. J Am Assoc Nurse Pract 2022; 34:1116-1125. [PMID: 36099396 DOI: 10.1097/jxx.0000000000000771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Nurse practitioners (NPs) and physician assistants (PAs) have an important role in delivery of care in a tertiary children's hospital emergency department (ED). Most NPs and PAs have not had any formal training to work in a pediatric ED; although our NPs and PAs had no formal ED training, some were acute care certified. We describe a curriculum designed to improve knowledge and skills of NPs and PAs in the pediatric ED. The curriculum consists of three modules, namely, online lecture series, procedural workshops, and case scenarios in a simulated setting. Module 1 consisted of online lecture on 10 common ED diagnoses. The second module consisted of procedural workshops on lumbar puncture, incision and drainage of abscesses, gastrostomy insertion, and laceration repair. The third module included simulation scenarios on ED-specific cases of seizure in an infant, bronchiolitis and ruptured appendicitis with shock. Each module was evaluated by a survey. Participants rated each item on the survey using a Likert scale response (1 = disagree completely to 5 = agree completely). Both NPs and PAs demonstrated increase in knowledge scores in posttest 1 vs pretest (p < .001) and did not show a significant decline in posttest 2 (p = .073). The mean ratings of components of the online lecture series, workshops, and simulation scenarios were 4.5-4.7, 4.4-4.8, and 4.5-4.7, respectively, with positive comments. This novel curriculum meets the educational needs of NPs and PAs at our institution and can be used as a model to train them at other tertiary care pediatric EDs.
Collapse
|
3
|
Marco CA, Courtney DM, Ling LJ, Salsberg E, Reisdorff EJ, Gallahue FE, Suter RE, Muelleman R, Chappell B, Evans DD, Vafaie N, Richwine C. The Emergency Medicine Physician Workforce: Projections for 2030. Ann Emerg Med 2021; 78:726-737. [PMID: 34353653 DOI: 10.1016/j.annemergmed.2021.05.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians. METHODS To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios. RESULTS The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030. CONCLUSION The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative.
Collapse
Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH.
| | - D Mark Courtney
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Louis J Ling
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Edward Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
| | | | - Fiona E Gallahue
- Department of Emergency Medicine, The University of Washington, Seattle, WA
| | - Robert E Suter
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX; Department of Community Medicine, Oklahoma State University, Tulsa, OK; Department of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Robert Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bradley Chappell
- Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Nathan Vafaie
- Emergency Medicine Residents' Association (EMRA), Dallas, TX
| | - Chelsea Richwine
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
| |
Collapse
|
4
|
Dowling Evans D, Hoyt KS, Davis WD, Wilbeck J. Revisioning the ENP Among Emergency Workforce Changes: Specialty or Population? Adv Emerg Nurs J 2021; 43:171-177. [PMID: 34397491 DOI: 10.1097/tme.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dian Dowling Evans
- Guest Editor Professor and Director Family/Emergency Nurse Practitioner Program Nell Hodgson Woodruff School of Nursing Emory University Atlanta, Georgia
| | - K Sue Hoyt
- Professor, ENP/NP Programs, University of San Diego Hahn School of Nursing and Health Science Beyster Institute for Nursing Research San Diego, California
| | - Wesley D Davis
- Assistant Professor Dual Family Nurse Practitioner/Emergency Nurse Practitioner Track Coordinator Emergency Nurse Practitioner Specialty Coordinator University of South Alabama Mobile, Alabama President-Elect American Academy of Emergency Nurse Practitioners Leander, Texas
| | - Jennifer Wilbeck
- Professor and Director ENP Specialty Vanderbilt University School of Nursing Nashville, Tennessee Executive Director American Academy of Emergency Nurse Practitioners Leander, Texas
| |
Collapse
|
5
|
Sun S, Lu SF, Rui H. Does Telemedicine Reduce Emergency Room Congestion? Evidence from New York State. INFORMATION SYSTEMS RESEARCH 2020. [DOI: 10.1287/isre.2020.0926] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Overcrowding in emergency rooms (ERs) is a common yet nagging problem. It not only is costly for hospitals but also compromises care quality and patient experience. Our paper provides solid evidence that telemedicine can significantly improve ER care delivery, especially in the presence of demand and supply fluctuations. We believe such findings are critical for ERs, due to the special setting of unscheduled arrivals leading to high unpredictability of patient traffic. Additional evidence suggests that the efficiency gained from telemedicine does not come at the expense of lower care quality or higher medical expenditure, which points to telemedicine as a feasible solution to the ER overcrowding problem. For healthcare practitioners, our paper highlights the general applicability of telemedicine through the “hub and spoke” architecture. Besides increasing patients’ access to more immediate care from specialists who were not available otherwise, telemedicine enables flexible resource allocation for any hospitals, regardless of where hospitals are located. Our research also provides ground for policymakers to incentivize hospitals to adopt telemedicine in ER, which we believe is critical given the relatively low adoption rate, the lack of direct evidence on its effectiveness, and the current inflexibility of reimbursement policies regarding the application of ER telemedicine.
Collapse
Affiliation(s)
- Shujing Sun
- Simon Business School, University of Rochester, Rochester, New York 14627
| | - Susan F. Lu
- Krannert School of Management, Purdue University, West Lafayette, Indiana 47907
| | - Huaxia Rui
- Simon Business School, University of Rochester, Rochester, New York 14627
| |
Collapse
|
6
|
Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers? J Am Assoc Nurse Pract 2020; 32:447-458. [DOI: 10.1097/jxx.0000000000000263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
7
|
Clark A, Amanti C, Sheng AY. Supervision of Advanced Practice Providers. Emerg Med Clin North Am 2020; 38:353-361. [DOI: 10.1016/j.emc.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Abu Jawdeh EG, Hardin-Fanning F, Kinnard TB, Cunningham MD. Neonatal postgraduate training program for physician assistants: meeting a need in neonatal care. J Perinatol 2019; 39:746-753. [PMID: 30858612 DOI: 10.1038/s41372-019-0350-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/18/2019] [Indexed: 11/09/2022]
Abstract
There is a growing need for advanced practice providers in the NICU. Physician assistants (PAs) with postgraduate training in neonatology can help meet these demands. The premise of training PAs to work in the NICU is being adopted by multiple centers nationwide. Unfortunately, there are no standardized curricula for neonatal PA training that can be utilized to initiate residencies. Since our program is the longest running neonatal PA residency in the nation, we are in a unique position to share the accumulated experiences of our curriculum development. In this article, we describe our neonatal PA residency as it exists today with selected lessons learned. In addition, we present mixed qualitative and quantitative assessments of graduates. We believe that neonatal PA residency graduates become ideal candidates to fill the growing national need. We propose that our model program can be a stepping stone to enhance the role of PAs in neonatal care.
Collapse
Affiliation(s)
- Elie G Abu Jawdeh
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
| | | | - Tria B Kinnard
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
| | - M Douglas Cunningham
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
9
|
De Bruijn-Geraets DP, van Eijk-Hustings YJL, Bessems-Beks MCM, Essers BAB, Dirksen CD, Vrijhoef HJM. National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants. BMJ Open 2018; 8:e019962. [PMID: 29934382 PMCID: PMC6020970 DOI: 10.1136/bmjopen-2017-019962] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making. DESIGN Nationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups). METHODS Surveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015. RESULTS Quantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled. CONCLUSIONS Informal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.
Collapse
Affiliation(s)
- Daisy P De Bruijn-Geraets
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Yvonne J L van Eijk-Hustings
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Monique C M Bessems-Beks
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Brigitte A B Essers
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Carmen D Dirksen
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
- Panaxea, Amsterdam, The Netherlands
- Department of Primary Care, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
10
|
Jiao S, Murimi IB, Stafford RS, Mojtabai R, Alexander GC. Quality of Prescribing by Physicians, Nurse Practitioners, and Physician Assistants in the United States. Pharmacotherapy 2018; 38:417-427. [PMID: 29457258 DOI: 10.1002/phar.2095] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares with that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and nonphysician providers. METHODS A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey was performed. Ambulatory care services in physician offices, hospital emergency departments, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, NPs, and PAs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. RESULTS A total of 701,499 sampled patient visits were included during the study period, representing ~8.33 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; NPs and PAs each accounted for 1.6% of these visits. The proportion of eligible visits where quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for congestive heart failure) to 89.5% (avoidance of inappropriate medications among elderly). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between nonphysicians and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by NPs and PAs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. CONCLUSIONS Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by nonphysicians and physicians was generally comparable.
Collapse
Affiliation(s)
- Shiyin Jiao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland.,Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Irene B Murimi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland
| | - Randall S Stafford
- Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Ramin Mojtabai
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Psychiatry, Johns Hopkins Medicine, Baltimore, Maryland
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| |
Collapse
|
11
|
Eastern Association for the Surgery of Trauma and Society of Trauma Nurses advanced practitioner position paper: Optimizing the integration of advanced practitioners in trauma and critical care. J Trauma Acute Care Surg 2017; 83:190-196. [PMID: 28328684 DOI: 10.1097/ta.0000000000001455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse practitioners and physician assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma, the Society of Trauma Nurses, and the American Association of Surgical Physician Assistants acknowledge the value of APs and support their utilization in the management of injured and critically ill patients. This position paper offers insight into the history of, scope of practice for, and opportunities for optimal utilization of APs in trauma, critical care, and acute care surgery services.
Collapse
|
12
|
Commentaries on health services research. JAAPA 2015. [DOI: 10.1097/01.jaa.0000472635.29139.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|