Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System

Althausen, Peter L.; Shannon, Steven F.; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J.

doi:10.1097/bot.0b013e3182647f29

Cited by 30 publications

(48 citation statements)

References 21 publications

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“…[28][29][30][31] The two systematic reviews (one general 30 and one specific to primary care 31 ) noted that the quality of most studies was weak to moderate and there was limited evidence on resource utilisation, costs and cost-effectiveness. Three small US studies of PAs in hospital settings published in 2013 and 2014 provided new positive evidence as to the contribution that PAs made to patient outcomes and resource use in a trauma-orthopaedic setting 32 and in low-and high-acuity emergency department (ED) settings. 33,34 One study 35 had reported that the indirect impact of employing PAs in a general surgical residency programme was to reduce the resident doctor workload, increase the doctors' ability to attend their training activities and improve results in their American Board of Surgery in Training Examination.…”

Section: Physician Associatesmentioning

confidence: 99%

“…Six papers reported on PAs working in trauma and orthopaedics. 32,[101][102][103][104][105][106] PAs were substituting for doctors (residents 105 and GP surgical assistants 101,103 ) in three of these studies.…”

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

“…32,101,105 PAs acting as substitutes for doctors were reported to shorten waiting times in the ED but the authors attributed this in part to other service redesign, such as there being more registered nurses. 32,105 Waiting times for surgical procedures were also reported to be reduced, 101 attributed by the authors to the use of two operating theatres by the surgeon, made possible by the PA preparing and finishing the case. However, one study examining in detail the impact of PAs in teams on time to, in and from theatre found no statistically significant difference.…”

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

“…However, one study examining in detail the impact of PAs in teams on time to, in and from theatre found no statistically significant difference. 32 In two studies, PAs were found to release the time of doctors for other activities: for supervising physicians for 2 hours a day 32,103 and for GPs (not quantified), who had previously acted as surgical assistants. 101 Length of hospital stay was examined in three high-quality studies, 32,104,105 with one showing a significant reduction (of 3 to 4 hours) for all patients when PAs were an addition to staffing.…”

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

“…104 The studies in which PAs substituted for doctors found no difference in length of stay. 32,105 Health outcomes were reported as improved in two studies. 32,104 One study reported that the presence of PAs decreased postoperative complications measured by antibiotic and deep-vein thrombosis prophylaxis use.…”

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

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The role of physician associates in secondary care: the PA-SCER mixed-methods study

Drennan

Halter

Wheeler

et al. 2019

Health Serv Deliv Res

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BackgroundIncreasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.Objectives(1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.MethodsThis was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.ResultsThe surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57;p = 0.40). In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.LimitationsPAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team.ConclusionsPAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice.Future researchComparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners.Study registrationThe systematic review component of this study is registered as PROSPERO CRD42016032895.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Physician Associatesmentioning

confidence: 99%

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

Section: Trauma and Orthopaedicsmentioning

confidence: 99%

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The role of physician associates in secondary care: the PA-SCER mixed-methods study

Drennan

Halter

Wheeler

et al. 2019

Health Serv Deliv Res

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A profile of surgical burden and anaesthesia services at Mozambique's Central Hospital: A review

Kynes

Walters

Pinto

et al. 2018

International Journal of Surgery

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This profile of anaesthesia services at a large tertiary hospital in Mozambique highlights several features of anaesthesia care and surgical burden in LICs, including challenges of resource limitations, patient comorbidity, and social dynamics present in Mozambique that contribute to prolonged hospital stays. As noted, enhanced data collection and analysis within the department and the hospital may be useful in identifying strategies to improve outcomes and patient safety.

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Impact of Nurse Practitioners on Hip Fracture Length of Stay

Holte

Sems

Fruth

2015

The Journal for Nurse Practitioners

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Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System

Cited by 30 publications

References 21 publications

The role of physician associates in secondary care: the PA-SCER mixed-methods study

The role of physician associates in secondary care: the PA-SCER mixed-methods study

A profile of surgical burden and anaesthesia services at Mozambique's Central Hospital: A review

Impact of Nurse Practitioners on Hip Fracture Length of Stay

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