Hi Errn,
The use of physician's assistants in emergency medicine has been a
pretty hot topic for several years, as I found in my research. Most
articles compare the success rates (based on length of stay, rapidity
of treatment/admission, or patient satisfaction) of PAs with ER
physicians rather than with NPs, but a few look at all types of
"physician extenders" as well. I've pulled out thirty articles from
the CINAHL and PubMed databases that I think will have some utility
for you - the best place to go to get the articles themselves will be
to your hospital library or (if you have one) your local Area Health
Education Center or equivalent.
I do want to note that most of the articles indicate positive outcomes
for the use of PAs. Major obstacles to overcome are the perception of
the PA by NPs and by physicians (both can perceive the PA as a threat)
and by patients (who may not know that they're not being treated by a
physician - people get confused about med school clerks vs. interns
vs. residents vs. "house staff" vs. NPs vs. physicians already!).
Also, there are different regulations for what kind of unsupervised
work a PA can do compared to an RN. There also appeared to be some
concern that introducing PAs into the staffing mix of an ER just
caused problems along the lines of "too many cooks spoil the soup."
Please let me know if you need clarification on this request
(preferably before giving a rating!).
Yours, librariankt
I found the following 11 articles in CINAHL (Cumulative Index to
Nursing and Allied Health Literature) using the search ?(((MH
"Physician Assistants")) and (MH "Nurse Practitioners")) And
(emergency OR trauma)?.
Trends: trends in the supply of physician assistants and nurse
practitioners in the United States: if numbers of NPs continue to
fall, some underserved populations might not receive even the levels
of primary care they do now
Hooker RS; Berlin LE
Health Affairs, 2002 Sep-Oct; 21(5): 174-81
In 2001 an estimated 103,612 nurse practitioners (NPs) and physician
assistants (PAs) were in clinical employment in the United States. The
roles of PAs and NPs in providing comparable physician services are
similar; they differ in that NPs are predominantly in primary care,
while PAs are divided between primary and specialty care. PA and NP
education processes also differ in the student pool and trends in the
output. The combined number of graduates totaled 11,585 in 2001.
However, the annual number of NP graduates is declining, while the
number of PA graduates is increasing. These observations have
implications for the future in the types of patients they see and the
degree of health care services they provide.
Assessment of emergency department health care professionals'
behaviors regarding HIV testing and referral for patients with STDs
Fincher-Mergi M; Cartone KJ; Mischler J; Pasieka P; Lerner EB; Billittier AJ IV
AIDS Patient Care and STDs, 2002 Nov; 16(11): 549-53
The objective of this study was to evaluate human immunodeficiency
virus (HIV) counseling, testing, and referral practices of emergency
department health care professionals (i.e., medical doctors [MD],
physician assistants [PA], nurse practitioners [NP], and registered
nurses [RN]) for patients presenting with other sexually transmitted
diseases (STD). All health care professionals from 10 emergency
departments in a northeastern county were asked to complete an
anonymous survey. The surveys were returned by 154 (41%) health care
professionals (RN = 99, NP = 5, PA = 7, MD = 39, other = 4). The
average years in practice were 11. Only 7% of respondents were
certified to provide state mandated HIV pretest counseling
(certification not required for MD). Respondents reported caring for
an average of 13 patients per week with suspected STD. Fifty-five
percent of respondents reported that they always or usually warn STD
patients of their HIV risk, yet only 10% always or usually encouraged
these patients to consent to HIV testing in their emergency department
(RN = 7%, NP = 25%, PA = 0%, MD = 16%). Reasons for not offering HIV
testing in their emergency department were follow-up concerns (51%),
not certified to provide pretest/posttest counseling (45%), and too
time consuming (19%). Twenty-seven percent of respondents indicated
HIV testing was not available in their emergency department despite
all hospital laboratories reporting HIV testing capability.
Ninety-three percent of respondents were aware that confidential
testing sites were available, but only 35% always or usually referred
patients not tested in the emergency department elsewhere for testing.
Emergency department health care professionals frequently fail to
provide HIV counseling, testing, and/or referral for patients with
suspected STD
Nurse practitioners and physician assistants revisited: do their
practice patterns differ in ambulatory care?
Mills AC; McSweeney M
Journal of Professional Nursing (J PROF NURS), 2002 Jan-Feb; 18(1): 36-46
The education and regulation of nurse practitioners and physician
assistants would suggest unique role differentiations and practice
functions between the professions. This study explored to what extent
their practice patterns in primary care actually differ. It was
hypothesized that the primary care services provided by nurse
practitioners would tend to be women and family health services,
health prevention and promotion oriented, provided to minority and
socioeconomic disadvantaged patients, and less dependent on physician
supervision. In contrast, the services provided by physician
assistants would more likely be medical/surgical oriented; diagnostic,
procedural, and technical in nature; likely to be in rural areas; and
more dependent on physician supervision. The study used patient data
from the National Ambulatory Medical Care Survey and National Hospital
Ambulatory Medical Care Survey. Although some differences emerged, the
argument is not compelling to suggest strong, unique, practice
differences across all ambulatory care settings between the two types
of nonphysician providers. It is the specific type of ambulatory
setting that influences the practice pattern for both provider groups.
If practice patterns are less distinctive than previously believed,
more opportunities for interdisciplinary education need to be
explored, and health policies that promote a discipline-specific
primary care workforce may need to be reexamined.
Managers forum. Cutting-edge discussions of management, policy, and
program issues in emergency care: How are nurse practitioners used in
a trauma service, compared with physicians assistants?
McCracken B; Keough V
Journal of Emergency Nursing (J EMERG NURS), 2001 Oct; 27(5): 497-8
Comprehensive trauma patient care by nonphysician providers
Sole ML; Hunkar-Huie AM; Schiller JS; Cheatham ML
AACN Clinical Issues: Advanced Practice in Acute and Critical Care
(AACN CLIN ISSUES ADV PRACT ACUTE CRIT CARE), 2001 Aug; 12(3): 438-46
Nonphysician providers are being increasingly used to care for trauma
patients. As these complex patients recover, they require meticulous
medical management and time-consuming psychosocial care. A
retrospective evaluation of a unique patient care service staffed by
nonphysician providers is presented. The Intermediate Care Service is
designed to facilitate the management and long-term placement of
trauma patients who no longer require intensive care while recovering
from their injuries. The new diagnoses, physician order changes, and
disposition of 93 patients cared for during a 6-month period are
described. Most patients were admitted with neurologic injury. The
most common new diagnosis was constipation; the most frequent new
orders related to medications, including bowel management, and
rehabilitation consultations. All patients were discharged from the
hospital. The Intermediate Care Service represents a unique and
valuable model for the collaborative management of complex trauma
patients.
Using nonphysicians for MSEs: 'Is it worth it?'
ED Management (ED MANAGE), 2001 Apr; 13(4): 40-1
Intracranial pressure monitor placement by midlevel practitioners
Kaups KL; Parks SN; Morris CL
Journal of Trauma: Injury, Infection, and Critical Care (J TRAUMA INJ
INFECT CRIT CARE), 1998 Nov; 45(5): 884-6
Background: The timely treatment of patients with head injuries is
affected by the availability and commitment of neurosurgeons. Use of
midlevel practitioners (MLPs) may permit more efficient neurosurgical
coverage. Intracranial pressure monitoring is among the most
frequently used neurosurgical procedures. The purpose of this study
was to examine the placement of intracranial pressure (ICP) monitors
by MLPs. Methods: Medical records and trauma registry data for a Level
I trauma center were reviewed from December 1993 to June 1997.
Patients who had ICP monitors placed were included. Patient data
recorded were age, mechanism of injury, injury type, ICP monitor
placement and length of placement, complications related to the ICP
monitor, and outcomes. Results: Two hundred ten patients had 215
monitors placed. ICP monitors were placed by neurosurgeons (105), MLPs
(97), and general surgery residents (13), and remained in place a mean
of 4 days. No major complications attributable to ICP monitor
placement occurred; 19 minor complications (malfunction, dislodgment)
were noted. Eleven monitors placed by neurosurgeons (10%), seven
placed by MLPs (7%), and one placed by a resident (8%) had
complications. Conclusion: ICP monitor placement by MLPs is safe. Use
of MLPs may aid neurosurgeons in providing prompt monitoring of
patients with head injuries.
Use of PAs and NPs in US hospital emergency departments, 1993-1994
McCaig LF
JAAPA/Journal of the American Academy of Physician Assistants (JAAPA J
AM ACAD PHYSICIAN ASSIST), 1998 Jan; 11(1): 38, 40-2, 45-6 passim
Data from the from the 1993-1994 National Hospital Ambulatory Medical
Survey (NHAMCS) were analyzed to compare emergency department (ED)
visits in which the patient was seen by a PA or nurse practitioner
(NP), or both (called PA-NP ED visits), with ED visits to all
providers. Sample data were weighted to produce national estimates.
Estimates presented are annual averages for the 2-year period. In 1993
and 1994, 92 million ED visits were made each year in the United
States; PA-NP ED visits constituted 3.5% of all ED visits. Compared
with ED Data visits to all providers (47%), a greater percentage of
PA-NP ED visits involved patients 15 to 44 years of age (55%). Few
differences were found between PA-NP ED visits and visits to all
providers for reason for visit, principal diagnosis, and medication.
Beyond the care they provide in physicians' offices and other
nonhospital settings, PAs and NPs make an important contribution to
health care delivery in hospital EDs.
PAs, NPs in ED require careful hiring, training: here's how to get the
most bang for your buck... physician assistants... nurse practitioners
Patient Focused Care (PATIENT FOCUS CARE), 1997 Oct; 5(10): 113-5
PAs and NPs in an emergency room-linked acute care clinic
Currey CJ
Physician Assistant (PHYSICIAN ASSIST), 1984 Dec; 8(12): 39, 43, 53
Emergency medicine physician extenders
Simm KA; Whitcraft DD
Topics in Emergency Medicine (TOP EMERG MED), 1991 Sep; 13(3): 62-9
In addition, I found the following 19 articles in PubMed (MEDLINE)
using the search
?("Emergency Medical Services"[MeSH] OR "Emergency Service,
Hospital"[MeSH] OR "Triage"[MeSH]) AND "Physician Assistants"[MeSH]?
1: American Journal of Emergency Medicine. 2003 Mar;21(2):125-8.
Coping with a crowded ED: an expanded unique role for midlevel providers.
Ganapathy S, Zwemer FL Jr.
Crowding in the emergency department (ED) has multiple causes,
including space and staffing in both inpatient areas and the ED.
Waiting for inpatient beds is the primary issue in our ED. Waiting
inpatients require continuing care and attention from
emergency-medicine (EM) physicians. As a managerial response, we
developed a unique role for midlevel practitioners (MLPs) in which
they could provide "back-end" work for patients awaiting inpatient
beds. After initial EM physician evaluation, patients without ready
inpatient beds were grouped in the ED and their care was transferred
to the transition team (TT). The TT consisted of an MLP (nurse
practitioner or physician assistant) and a registered nurse or
licensed practical nurse, all reporting to ED supervisors. MLPs were
readily available from the local medical professional market. The TT
provided all patient care until a patient was seen by the admitting
inpatient service or until the patient left for an inpatient unit. The
major TT objectives were a reduction of EM physician work in caring
for inpatients, and improved patient care. We demonstrated that the TT
assumed a significant patient load, an indirect measure of reduced EM
physician work, but this did not improve patient satisfaction. The TT
clinical role is less desirable to MLPs than are other traditional
clinical roles. The TT is a potentially available, incremental
staffing resource for a crowded ED.
2: Annals of Emergency Medicine. 2002 Nov;40(5):547-8.
Guidelines on the role of physician assistants in the emergency department.
American College of Emergency Physicians. Emergency Medicine Practice Committee.
Available online: http://www.acep.org/1,584,0.html
Note: the guidelines for the use of NPs is also online:
http://www.acep.org/1,583,0.html
3: JAAPA. 2001 Dec;14(12):22-4, 27-38; quiz 49-50.
What impact on PA education? A snapshot of ambulatory care visits involving PAs.
Hachmuth FA, Hootman JM.
This study uses data from the 1997 National Ambulatory Medical Care
Survey and the National Hospital Ambulatory Medical Care Survey to
describe nonfederal physician office, hospital outpatient, and
emergency department visits involving physician assistants (PAs). Of
an estimated 959 million visits to health care practitioners, 2.55%
(an estimated 24,532,000) involved PAs. Diagnoses associated with
ambulatory care visits involving PAs included well-infant and
well-child examinations and the care of uncomplicated injuries or
wounds and respiratory tract infections. On average, 3.1 medications
were ordered or provided at a visit with a PA. The problems that PAs
address are similar across the 3 ambulatory care settings analyzed,
with some expected variation between physician office and emergency
department visits. Generally, ambulatory care visits with PAs mirror
visits with all health care providers who practice ambulatory care
medicine. PA education programs should ensure that students can
competently perform the skills needed for typical ambulatory care
practice.
4: Accident and Emergency Nursing. 2001 Apr;9(2):86-91.
The Boston experience.
Loveridge BN.
In April 2000, three nurses from Chesterfield (UK) were successful in
an application for a travel scholarship. The scholarship was to
examine emergency nurse practitioner (ENP) schemes in Boston USA after
completion of my dissertation based on the same subject, in the course
of which the broad span of ENP work had become obvious to me. Leading
up to the trip overseas, we discussed specific objectives we hoped to
meet but we did not expect the range of experiences we were exposed to
within this busy city. It became apparent while in Boston, that we
should avoid becoming too focused otherwise we might miss valuable
information or experiences which would benefit practice back in the
UK. Six of the most striking issues, which impressed all three of us,
are covered in this paper. These are then reflected back to UK
practice in an attempt to discover whether these experiences can
benefit our own profession. Subjects covered include: student
training; ENP training and role parameters; physician assistants;
primary care and the effect of information technology on the emergency
care culture.
5: JAAPA. 2001 Jun;14(6):7-8.
Clearing the ED of smoke, confusion, and a crowd.
DiMaggio C.
6: JAAPA. 2000 Dec;13(12):39-40, 49-50, 53-4 passim.
Patient care by physician assistants and by physicians in an emergency department.
Arnopolin SL, Smithline HA.
OBJECTIVE: Decreasing health care dollars have resulted in increased
utilization of so-called midlevel practitioners. We compared emergency
physicians with emergency department physician assistants (PAs) to
determine whether PAs are an appropriate option for providing services
rendered by physicians in this setting. METHODS: We undertook an
observational retrospective review of a hospital database (July 1995
to June 1996) from an urban urgent-care facility. Collection of data
was restricted to times of single-provider coverage. Every patient who
visited the clinic was seen by the sole provider (physician or PA) on
duty; no one was turned away. If a patient needed emergency care, he
(or she) was transferred to the main emergency department at the
hospital, as deemed appropriate by either provider after evaluation.
Physicians and PAs were compared in regard to length of visit and
total charges in 14 diagnostic groups. Adverse outcomes were not
evaluated. Age, sex, race, and multiple diagnoses were controlled for
by regression analysis. RESULTS: A total of 9,601 patient encounters
were analyzed. PAs and physicians had a similar distribution of
diagnostic groups. Respiratory infection and musculoskeletal disorders
accounted for approximately 36% of visits; lacerations,
gastrointestinal disorders, and otitis each accounted for 5% of
visits. Overall, visits were 8 minutes longer and total charges $8
less when a patient was treated by a PA. Patients who had headache,
otitis, respiratory infection, asthma, gastrointestinal or
genitourinary disorder, cellulitis, laceration, or other
musculoskeletal disorder had a longer visit when seen by a PA; the
difference ranged from 5 to 32 minutes longer. In no diagnostic group
was there a statistically significant greater length of visit or total
charge because patients were seen by a PA. CONCLUSION: Despite a few
large differences in some diagnostic groups, the two types of provider
had, overall, small but clinically insignificant differences in length
of visit and total charges. The magnitude of difference in length of
visit and total charges strongly suggests that PAs, when compared with
physicians, are a viable staffing option in an urgent care facility.
7: ED Management. 2001 May;13(5):54-5.
Nonphysicians must follow protocols to the letter.
When performing medical screening examinations (MSEs), nonphysicians
must follow strict protocols and work under the supervision of the ED
physician. Numerous EMTALA violations have involved failure to follow
protocols and comply with scope of practice. Protocols must address at
what times a physician is required to be called. Individuals
performing MSEs must be formally assessed and approved by the
hospital's board of directors and be permitted by licensure to perform
this function.
8: American Journal of Emergency Medicine. 2000 Oct;18(6):661-5.
Patient satisfaction with physician assistants (PAs) in an ED fast track.
Counselman FL, Graffeo CA, Hill JT.
The study objective was to determine patient satisfaction with
physician assistants (PAs) in an emergency department (ED) fast track
(FT). An additional goal was to determine if patients would be willing
to wait longer to be seen primarily by an emergency physician (EP)
rather than a PA. The study was conducted between March 1, 1999 and
May 1, 1999 at a community hospital with an annual ED census of 48,644
patients; 18% are seen in the ED FT. All patients were seen primarily
by a PA. An anonymous survey was given to patients at time of
discharge. Patients rated their degree of satisfaction by placing an X
on a 100 millimeter visual analogue scale. Patients also indicated if
they would be willing to wait longer to be seen primarily by an EP
rather than a PA. A total of 111 surveys were analyzed, for a response
rate of 11%. Sixty-two patients (56%) were women and 49 men (44%),
with a mean age of 28 years. Twenty-seven patients (24%) were younger
than 18 years and required a legal guardian to complete the survey.
The mean patient satisfaction score was 93 (95% CI: 90.27 to 95.73).
Only 13 patients (12%) indicated they would be willing to wait longer
to be seen primarily by an EP rather than a PA. Patients seen in an ED
FT are very satisfied with the care rendered by a PA. Few patients
would be willing to wait longer in such a setting to be seen primarily
by an EP.
9: Journal of Accident and Emergency Medicine. 1999 Mar;16(2):114-6.
Doctor's assistants--do we need them?
Law H, Sloan J.
OBJECTIVE: To investigate the potential for the doctor's assistant
role within an accident and emergency (A&E) department in relation to
consultant workload. METHODS: A time and motion evaluation of the
activities of four A&E consultants before and after a doctor's
assistant was established as a team member within our department. A
review of the literature was undertaken to allow comparisons with the
American model of the physician assistant within the emergency
department. RESULTS: The initial evaluation indicated that over 20% of
the consultant's time could have been saved if an assistant were
available to perform a variety of non-medical tasks. The restudy
performed once the assistant was in post indicated less time was spent
by the doctors in "medical" clerical duties (6.7% v 11.5% time),
telephone use (5.6% v 7.7%), and venepuncture/cannula insertion (0.4%
v 2.1%), and more time was spent on consultation over cases (15.3% v
11.3%) and supervision of other staff (9.3% v 4.1%). These five areas
changed significantly (p = 0.005 by paired t test). CONCLUSIONS: The
doctor's assistant may have a role in reprofiling the workload of
senior doctors in A&E departments in the UK. They may also have a role
in reducing the pressure on junior doctors, though this effect was not
evaluated.
10: Southern Medical Journal. 1998 Apr;91(4):354-7.
Emergency medicine practice systems in Louisiana.
Waldrop RD, Mandry C, Rios J, Grate I.
BACKGROUND: We surveyed emergency medicine practice systems in
Louisiana. METHODS: We surveyed 105 emergency department (ED)
directors in Louisiana requesting annual ED volume, hospital type,
physician coverage scheduled, type of documentation used, use of
physician extenders, use of minor care or observation areas, and
employment status of emergency physicians. RESULTS: Directors of 71
EDs responded. Eighty-six percent of emergency physicians were
employed as independent contractors. Public and teaching EDs accounted
for 51% and 23%, respectively. Mode of documentation was handwritten
in 56% and dictated in 21%; 23% used a combination. Physician
extenders were used in 7%, with 4% using physician assistants and
nurse practitioners. Minor care areas were used in 17%, observation
areas in 25%. Nonteaching EDs had a significantly less mean annual
volume and physician hours scheduled; they also treated significantly
fewer patients per hour. Emergency departments using dictation,
physician extenders, or accessory care areas had significantly greater
mean annual patient volumes. CONCLUSIONS: Emergency departments in
teaching hospitals, using dictation, physician extenders, and
accessory care areas, have significantly greater system productivity
than nonteaching hospitals.
11: Journal of Trauma. 1998 Feb;44(2):372-6.
Use of physician assistants as surgery/trauma house staff at an
American College of Surgeons-verified Level II trauma center.
Miller W, Riehl E, Napier M, Barber K, Dabideen H.
BACKGROUND: Historically, surgical physicians staff trauma centers,
which provide trauma patients with improved outcomes. Such benefits
fuel the expansion of designated trauma centers. Cutbacks in residency
programs of surgical specialties, however, necessitate substitutions
for traditional trauma providers. METHODS: A literature and record
review was conducted to examine the use of physician assistants in a
large community hospital's verified trauma center. Current and
historical outcomes were analyzed regarding the trauma
surgeon/physician assistant model. RESULTS: Injury Severity Scores
increased 19%, transfer time to the operating room decreased 43%,
transfer time to the intensive care unit decreased 51%, and transfer
time to the floor decreased 20%. The length of stay for admissions
decreased 13%, and the length of stay for neurotrauma intensive care
unit patients decreased 33%. CONCLUSION: The Hurley Medical Center
trauma surgeon/physician assistant model is a viable alternative for
verified trauma centers unable to maintain a surgical residency
program. Consistency and quality of care indicated by shortened length
of stay is a hallmark of such a model providing the highest quality of
care.
12: Patient Focused Care. 1997 Sep;5(9):102-3.
Hire midlevel practitioners to lower costs in EDs.
13: American Journal of Emergency Medicine. 1997 May;15(3):229-32.
Use of physician extenders and fast tracks in United States emergency departments.
Ellis GL, Brandt TE.
To describe current practice regarding the use of physician extenders
(PEs) and the "fast track" (FT) concept in United States emergency
departments (EDs), a telephone survey of 250 US health care facilities
offering emergency services was conducted. Of the EDs surveyed, 21.6%
were using PEs at the time of the survey, and of those not using PEs,
23.5% intended to do so within the next 2 years. Those using PEs had
been using them for a mean duration of 3.5 years (the mode was 2
years). The mean number of hours of PE coverage was 11.4 hours on
weekdays and 11.5 hours on weekends (the mode was 12 hours both on
weekdays and weekends). In general, the use of PEs increased with
increasing hospital size and ED census, in more urban settings, in
teaching facilities, and in the Northeast region of the country.
Thirty percent of EDs surveyed had FT, and of those that did not have
FT at the time of the survey, 32.8% intended to institute FT within 2
years. Of those that had FT, the mean number of years in use was 2.4
(the mode was 2). The use of FT increased with increasing hospital
size and ED census, in teaching hospitals, and in the Northeast
region. FT was most common in the suburban setting. The mean estimated
percentage of ED patients going through FT was 30.1%. The mean number
of hours per day of FT operation was 13.4 hours on weekdays and 13.7
hours on weekends (the mode was 12 hours/day both on weekdays and
weekends). Of hospitals using PEs in the ED, 56.0% had FT; of
hospitals without PEs in the ED, 23.5% had FT.
14: American Journal of Emergency Medicine. 1996 May;14(3):338-9.
Physician assistants in control: ED mayhem.
Hall GJ.
15: American Journal of Emergency Medicine. 1996 May;14(3):245-9.
Emergency department uses of physician assistants and nurse
practitioners: a national survey.
Hooker RS, McCaig L.
A study was undertaken to determine the extent to which physician
assistants (PAs) and/or nurse practitioners (NPs) are a source of
health care delivery in emergency departments (EDs) in the United
States. The National Hospital Ambulatory Medical Survey (NHAMCS) uses
a multistage probability sample that examines patient visits within
EDs. The sample included 437 hospitals with EDs. Visits were mostly
from self-referred patients to EDs within nonfederal, short-stay
hospitals, or general hospitals. Analysis of NHAMCS data found that a
PA and/or NP was seen for 3.5 million ED visits in 1992. Remarkably
little difference in gender, reason for visit, diagnosis, and
medication prescribed was found between PA/NP visits and visits to all
providers. This was the first study that systematically identified the
extent of PA/NP-delivered ED services in the United States and
compared it with physician services. Overall, PAs and NPs were found
to be significant sources of health care service for hospital EDs.
They are involved in care for almost 4% of all ED visits nationally
and manage a wider range of conditions than has been previously
reported. When types of visits are analyzed, including reasons for ED
care, diagnosis, and treatment, it appears that visits associated with
care by ED-based PA/NPs are similar to all ED visits, including those
attended by emergency medicine physicians. More studies are needed to
better understand the role of PAs and/or NPs in various ED settings.
Recruitment and use of PAs and NPs may be a cost-effective strategy
for improved delivery of emergency services.
16: Texas Medicine. 1995 Apr;91(4):7.
PA control creates emergency department mayhem.
Hall GJ.
17: Journal of Emergency Nursing. 1994 Jun;20(3):207-12; quiz 212-4.
Nurse practitioners in the emergency department: current issues.
Curry JL.
18: HMO Practice. 1990 Sep-Oct;4(5):167-8.
How do physician assistants practice in your HMO?
Richardson KM.
19: Annals of Emergency Medicine. 1990 Mar;19(3):304-8.
Physician assistants in emergency medicine.
Sturmann KM, Ehrenberg K, Salzberg MR.
Physician assistants (PAs) specially trained in emergency medicine can
be used effectively to work with emergency medicine physicians to
provide efficient and expedient high-quality patient care. The concept
of using PAs in the emergency department is reviewed, and items of
concern to professionals who are reluctant to use PAs are discussed.
Financial issues and malpractice risk are examined, and our experience
with patient perceptions is summarized. The PA program at Beth Israel
Medical Center is used as a case study to demonstrate the use and
integration of the PA within the division of emergency services.
Although a well-trained emergency physician is the gold standard for
quality patient care, cost-effective quality care for certain patient
complaints can be rendered acceptably by others. |
