A systematic review: The role and impact of the physician assistant in the emergency department

Doan, Quynh; Sabhaney, Vikram; Kissoon, Niranjan; Sheps, Sam; Singer, Joel

doi:10.1111/j.1742-6723.2010.01368.x

Cited by 50 publications

(52 citation statements)

References 53 publications

(93 reference statements)

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“…While they were found to be more reliable in assessing particular medical complaints, were more trusted with performing procedures and were approved of by ED staff and patients, there is limited evidence on whether they can improve patient flow or are a cost-effective response. 223 The physician assistant role is well embedded in the US health system, but not in the NHS, so may be of limited relevance. Workforce…”

Section: Workforcementioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Workforcementioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…In the USA, where the profession has been established for 45 years, more than 10% of all US PAs practise emergency medicine and 68% of teaching hospitals employ PAs in the emergency department. 1 Although the PA profession is in its infancy in the UK, emergency medicine is one of the most common specialties for British PAs.…”

Section: A New Kid On the Block: The Role Of Physician Associatesmentioning

confidence: 99%

A new kid on the block: the role of physician associates

Ritsema

2014

Clinical Medicine

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“…[5,6] While senior doctors may be consulted to address clinical decisions, there is a trend towards reduced physical presence to reflect on value conflicts and secure CL training bedside. [7] Similarly, the role of the nurse-in-charge has been reformulated from a more historical apprenticeship model to "chief supervisoronly" of the current quality management system at any given time.…”

Section: The Rationalementioning

confidence: 99%

Redefining clinical leadership for team-course development

Olsen

Husebø

Qvindesland

et al. 2015

JHA

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Objective: Value choices are rooted in the philosophical deliberations of Aristotle, Levinas and Gadamer. Balancing the needs of "the other" with societal and institutional needs to meet the objectives of "the cause" is core to the modern health systems priority setting debate. These value conflicts present themselves bed-side in the day-to-day decision-making processes. A clinical leadership (CL) framework should present solutions to this challenge. Methods: The definition of CL is redefined to include four key values involved in this value conflict. These are 1) trust, 2) quality, 3) responsiveness and 4) efficiency. A CL in Teams course curriculum and design was developed to link these values to tools and to context in the hospital. Results: A new definition of CL has provided a common formative framework useful in clinical settings for priority setting, evaluation and professional development. By the end of 2015 a total of 82 participants will have completed the course. It has been evaluated to be timely, feasible, flexible, relevant and sustainable. Conclusions: Values influence how clinical leaders operate and have an important impact on their leadership abilities and how they respond to challenges. For clinical leaders and teams to work effectively it is crucial to develop common basic values. Developing a set of tools and reflective practice to understand the inter-relationship between values and how they can conflict or reinforce each other, contributes to improved quality of service, patient-centred care and workforce satisfaction.

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A systematic review: The role and impact of the physician assistant in the emergency department

Cited by 50 publications

References 53 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

A new kid on the block: the role of physician associates

Redefining clinical leadership for team-course development

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