Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program

Abstract

Background: Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. Methods:A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post).Results: Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. Conclusion:After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.Contexte : Le manque de ressources et les inefficacités des services d'orthopédie au Canada créent des possibilités pour de nouveaux modèles de dotation et de mise à contribution des ressources existantes. Aux États-Unis, les adjoints au médecin sont des fournisseurs de soins courants dans les services spécialisés d'orthopédie comparativement au Canada qui en fait une utilisation limitée. Dans le cadre d'un grand projet de démonstration, Alberta Health Services (AHS) a créé un poste d'adjoint au méde-cin dans un programme de chirurgie des membres supérieurs en Alberta, au Canada, afin de démontrer le rôle de l'adjoint au médecin à 4 étapes des soins : préopératoire, opératoire, postopératoire et suivi. Méthodes :Une évaluation avec méthodes mixtes a été effectuée au moyen d'entrevues semi-structurées (n = 38), de sondages auprès de fournisseurs de soins (n = 28) et de patients (n = 47), et de données des nouveaux patients de la clinique sur 2 ans. Les données d'une expérience en salle d'opération double indiquaient le temps prévu et le temps réel de 3 étapes des chirurgies (pré, per et postopératoire).Résultats : À l'étape préopératoire, l'adjoint au médecin a établi la priorité des patients référés en chirurgie et redirigé les patients vers d'autres soins. Lors de la deuxième année de l'adjoint au médecin, nous avons observé une augmentation d...

The role of physician associates in secondary care: the PA-SCER mixed-methods study

“…Six papers reported on PAs working in trauma and orthopaedics. 32,[101][102][103][104][105][106] PAs were substituting for doctors (residents 105 and GP surgical assistants 101,103 ) in three of these studies.…”

“…However, one study examining in detail the impact of PAs in teams on time to, in and from theatre found no statistically significant difference. 32 In two studies, PAs were found to release the time of doctors for other activities: for supervising physicians for 2 hours a day 32,103 and for GPs (not quantified), who had previously acted as surgical assistants. 101 Length of hospital stay was examined in three high-quality studies, 32,104,105 with one showing a significant reduction (of 3 to 4 hours) for all patients when PAs were an addition to staffing.…”

“…Two studies found no overall difference between groups in mortality 105 and in the likelihood of fracture malunion. 102 Patient satisfaction was surveyed and reported as positive from a small 103 and large 101 number of respondents, without a comparator, in two studies. 101,103 Responses from staff were more equivocal, with physician team members being positive on the contribution of PAs and nursing staff expressing concern about the overlap of work.…”

“…102 Patient satisfaction was surveyed and reported as positive from a small 103 and large 101 number of respondents, without a comparator, in two studies. 101,103 Responses from staff were more equivocal, with physician team members being positive on the contribution of PAs and nursing staff expressing concern about the overlap of work. 101 A different study found that although staff appreciated the continuity and PA skills in the operating room, they did not consider that the role could offer everything a previous surgical extender did postoperatively, despite being collaborative team members.…”

“…101 A different study found that although staff appreciated the continuity and PA skills in the operating room, they did not consider that the role could offer everything a previous surgical extender did postoperatively, despite being collaborative team members. 103 There was also mixed evidence regarding impact on cost. One study in which PAs were an addition to the team reported specific cost savings in the ED and operating room, although it was noted that only 50% of PA costs were reimbursable.…”