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

Abstract

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.

A Review of Interprofessional Variation in Education: Challenges and Considerations in the Growth of Advanced Practice Providers in Emergency Medicine

“…For both PAs and NPs, most postgraduate training occurs as nonstandardized site‐specific on‐the‐job training. At present, there is no standardization for onboarding in EM, which has led health care organizations to create their own standards and on‐boarding processes 14 …”

“…At present, there is no standardization for onboarding in EM, which has led health care organizations to create their own standards and on-boarding processes. 14…”

Implementation of a Physician Assistant Emergency Medicine Residency Within a Physician Residency

“…The logistics of recruiting and credentialing of PA providers were similar to that of hiring non-resident PA providers and was based on institutional guidelines as well as best practices described in literature. 10 The university institutional review board approved our work as an exempted study.…”

“…Several EM-PA residencies exist, with prior publications outlining best practices in the logistics of some of these programs. 10 Although a recent cross-sectional study of EM-PA residencies identified that 93% of programs were in institutions that also had an EM residency program, it is unclear how the educational programs of their PA residents interacted with their respective MD residents. 2 The aim here was to describe an EM-PA residency collocated and embedded within an existing physician residency and demonstrate the feasibility of this interprofessional approach to EM-PA postgraduate training.…”

Advanced practice providers in academic emergency medicine: A national survey of chairs and program directors

“…Our results appear consistent with descriptive studies over the past decade that have noted an increase in APP presence across EDs. 7 Nearly all AACEM-member EDs are employing APPs (98%) and the vast majority of patients seen by APPs also involve attending physicians, ranging from 98% of high-acuity patients to 59% of low-acuity patients.…”