The role of physician assistants in pediatric emergency medicine: the physician's view

Abstract

Objective: To define the range of clinical conditions Canadian emergency pediatricians consider appropriate for management by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED). Methods: We conducted a cross-sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N 5 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions. Results: Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had $ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7-89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5-91.5% v. 82.2-84.7%). Conclusion: This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician. RÉ SUMÉObjectifs: L'é tude visait à dé finir une sé rie de troubles cliniques qui, de l'avis des pé diatres urgentologues au Canada, pourraient ê tre convenablement pris en charge par les auxiliaires mé dicaux (AM) ainsi que le degré d'autonomie que les AM devraient avoir dans les services d'urgence pé diatrique (SUP). Mé thode: Nous avons mené une enquê te transversale, pancanadienne, à l'aide d'un questionnaire é lectronique tiré de l'outil Active Campaign Survey, et nous avons ciblé les mé decins travaillant dans les SUP, qui utilisaient la base de donné es en ré seau du Groupe de recherche en urgence pé diatrique du Canada (n 5 297). Trois critè res d'é valuation ont é té retenus, soit les donné es dé mographiques, la bonne connaissance des AM, et le rô le clinique des AM dans les SUP. Le degré d'intervention des AM a é té é valué dans 57 troubles cliniques fré quents, non urgents. Ré sultats: Sur 297 mé decins, 152 ont rempli le questionnaire, ce qui a donné un taux de ré ponse de 51.2%. Aucun des 57 troubles cliniques retenus n'a obtenu un taux de convergence d'au moins 85% en ce qui concerne leur prise en charge par les AM sans intervention directe du mé decin. Vingt-quatre troubles cliniques ont obtenu un taux de convergence $ 15% dans lesquels toute intervention faite par les ...

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