Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners

Lohr, Robert H.; West, Colin P.; Beliveau, Margaret; Daniels, Paul; Nyman, M.; Mundell, William C.; Schwenk, Nina M.; Mandrekar, Jayawant N.; Naessens, James M.; Beckman, Thomas J.

doi:10.1016/j.mayocp.2013.08.013

Cited by 20 publications

(19 citation statements)

References 13 publications

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“…A retrospective cross‐sectional study was done at a single academic medical center using a sample of 286 patients, which was based on the sample from a previous study that examined the quality of referrals to the Division of General Internal Medicine . Specifically, the sample comprised patients referred to Mayo Clinic General Internal Medicine by primary care practices from January 1, 2009 to December 31, 2010.…”

Section: Methodsmentioning

confidence: 99%

“…Most patients were female (195/286). Initial case reviews were conducted by 5 experienced (>10 years) General Internal Medicine physicians in a blinded fashion for a study that examined the quality of referrals . For our study, an additional review was performed by 2 General Medicine physicians (RL and TB) to determine the level of agreement between the referral diagnoses and final diagnoses.…”

Section: Methodsmentioning

confidence: 99%

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Extent of diagnostic agreement among medical referrals

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Lohr

Beckman

et al. 2017

Evaluation Clinical Practice

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Extent of diagnostic agreement among medical referrals

Such

Lohr

Beckman

et al. 2017

Evaluation Clinical Practice

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“…Although state regulations differ in supervision between PAs and APRNs all our institutions have settled on consistent levels of supervision between both practitioner types to allow for ease of workflow. Of note, there are minimal data on the clinical care given by APPs when working independently, especially in the care of high‐acuity patients …”

Section: Discussionmentioning

confidence: 99%

Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations

Chekijian

Elia

Monti

et al. 2018

AEM Education and Training

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As emergency department (ED) visits continue to increase nationwide, the utilization of advanced practice providers (APPs) has been steadily increasing. Academic centers face unique challenges in the inclusion of APP staff into the educational and teaching environment. Effort should be made to both take advantage of and support the educational mission of academic centers while bolstering clinical care provided by APP staff. This paper highlights some of the considerations and challenges in incorporating APPs into academic EDs as of our common experience shows that best practices in supervision favor uniformity between resident and APP staff except with low-acuity patients. Likewise, professional development takes advantage of the educational environment to provide feedback and identify areas for improvement as well as development of formal clinical and educational curricula for APPs working in academic institutions. Already established medical doctor residencies can be leveraged to provide postgraduate education for APPs in either formal or informal training programs.

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“…A small patient sample was studied to assess referral patterns to an academic medical centre from physicians, NPs and PAs. About 30% of physician referrals were felt to be unnecessary, compared with 56% of mid‐level provider referrals, and about 60% versus 39%, respectively, of pre‐referral evaluations were felt to be appropriate …”

Section: Challenges and Contradictionsmentioning

confidence: 99%

Mid‐level providers and emergency care: Let's not lose the force

Tintinalli

2014

Emerg Medicine Australasia

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The progressive rise of ED visits globally, and insufficient numbers of emergency physicians, has resulted in the use of mid-level providers as adjuncts for the provision of emergency care, especially in the US and Canada. Military medics, midwives, aeromedical paramedics, EMT-Ps, flight nurses, forensic nurses, sexual assault nurse examiner nurses--are some examples of well-established mid-level provider professionals who achieve their clinical credentials through accredited training programmes and formal certification. In emergency medicine, however, mid-level providers are trained for general care, and typically acquire emergency medicine skills through on-the-job experience. There are very few training programmes for NPs and PAs in emergency care. The manpower gap for physicians in general, and emergency physicians specifically, will not be eliminated in the reasonable future. Mid-level providers--ENTs, paramedics, NPs, PAs--are an excellent addition to the emergency medicine workforce. However, the specialty of emergency medicine developed because specific and focused training was needed for physicians to practice safe and qualify emergency care. This same principle applies to mid-level providers. Emergency Medicine needs to develop a vision and a plan to train emergency medicine specialist NPs and PAs, and explore other innovations to expand our emergency care workforce.

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Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners

Cited by 20 publications

References 13 publications

Extent of diagnostic agreement among medical referrals

Extent of diagnostic agreement among medical referrals

Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations

Mid‐level providers and emergency care: Let's not lose the force

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