UBC Theses and Dissertations
Bringing physician assistants to Canadian pediatric emergency departments Doan, Quynh
Background and objectives: Pediatric emergency department (PED) utilization has increased, resulting in long waiting times for children and families. Extending PED physician coverage as a solution may not be cost effective or sustainable. Physician assistants (PAs), clinicians with roles tailored to assist physicians, have skills best suited to provide care in high volume and low complexity environments. As a large proportion of PED visits are for non-emergent problems, PAs are an alternative solution to increasing PED demand given constrained healthcare resources. Despite the growing acceptance of PAs, there are few studies evaluating their roles or cost-effeciency in PEDs. We assessed PA acceptance by Canadian healthcare users and providers, and estimated the impact of PAs on patient flow compared to extending physician coverage. Methods: The range and frequency of clinical complaints managed at a tertiary care PED was ascertained from an administrative database. Surveys of Canadian PED physicians defined a clinical scope of practice for PAs and estimated the proportion of PED visits a PA could manage, with varying degrees of physician supervision. Healthcare users were surveyed regarding their willingness to receive PA care. A discrete event simulation model of a PED was built to assess the impact of extending physician coverage versus adding PAs at equal incremental cost to the system, on waiting time, length of stay (LOS) and rate of patients leaving without being seen (LWBS). Results and interpretation: Provided that their waiting time was shortened, Canadians were willing to have their children receive care from PAs for minor injuries and non-emergent ailments. Although few Canadian PED physicians were familiar with PAs, most supported the concept of PA utilization for a large proportion of non-emergent visits. However, physicians wanted to remain directly involved thereby limiting PA autonomy. The simulation found important reductions in waiting time, LOS and LWBS rates for both scenarios: the extended physician model benefited all acuity levels, while the PA model with restricted PA autonomy favoured only highest acuity patients. Increasing the level of PA autonomy was critical in broadening the impact of PAs to all acuity levels.
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