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

CJEM ◽  
2013 ◽  
Vol 15 (06) ◽  
pp. 321-329 ◽  
Author(s):  
Quynh Doan ◽  
Shalea Piteau ◽  
Sam Sheps ◽  
Joel Singer ◽  
Hubert Wong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Work ◽  
Physician Assistants ◽  
Pediatric Emergency ◽  
Cross Sectional ◽  
Survey Tool ◽  
Clinical Encounters ◽  
Clinical Conditions ◽  
Selection Of

ABSTRACTObjective:To define the range of clinical conditions Canadian emergency pediatricians consider appropriate formanagement 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 = 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.

The Role of Physician Assistants in a Pediatric Emergency Department

2012 ◽  
Vol 28 (8) ◽  
pp. 783-788 ◽  
Author(s):  
Quynh Doan ◽  
Vikram Sabhaney ◽  
Niranjan Kissoon ◽  
David Johnson ◽  
Sam Sheps ◽  
...  
Keyword(s):  
Emergency Department ◽  
Physician Assistants ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

Management of Pleural Effusions in the Emergency Department.

2020 ◽  
Vol 15 ◽  
Author(s):  
MT Congedo ◽  
GM Ferretti ◽  
D Nachira ◽  
MA Pennisi
Keyword(s):  
Emergency Department ◽  
Systematic Approach ◽  
Acute Chest Pain ◽  
Pleural Effusions ◽  
Therapeutic Approaches ◽  
Massive Pleural Effusion ◽  
Emergency Department Setting ◽  
Clinical Conditions ◽  
Definitive Management

Background: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. Methods: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. Results: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. Conclusion: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

scholarly journals P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S104-S105
Author(s):  
P. Lee ◽  
I. Rigby ◽  
S.J. McPherson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Pediatric Emergency ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Period ◽  
Hand Off ◽  
Pediatric Inpatient ◽  
Didactic Lecture

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

scholarly journals The Effect of the COVID-19 Pandemic on the Pediatric Emergency Department Flow

2021 ◽  
pp. 1-25
Author(s):  
Andrea Rivera-Sepulveda ◽  
Timothy Maul ◽  
Katherine Dong ◽  
Kylee Crate ◽  
Talia Helman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Admission Rate ◽  
Severity Index ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chief Complaints

ABSTRACT Objective: To determine how the early stages of the COVID-19 pandemic affected the utilization of the Pediatric Emergency Department (PED). Methods: Cross-sectional study of PED visits during January through April, 2016-2020. Data included: total PED visits, emergency severity index (ESI), disposition, chief complaint, age (months), time from first Provider to Disposition (PTD), and PED length of stay (PED-LOS). P-value <0.01 was statistically significant. Results: In total, 67,499 visits were reported. There was a significant decrease in PED visits of 24-71% from March to April 2020. Chief complaints for fever and cough were highest in March 2020; while April 2020 had a shorter mean PED-LOS (from 158 to 123 minutes), an increase of admissions (from 8% to 14%), a decrease in ESI 4 (10%), and an increase in ESI 3 (8%) (p<0.001). There was no difference in mean monthly PTD time. Conclusions: Patient flow in the PED was negatively affected by a decrease in PED visits and increase in admission rate that may be related to higher acuity. By understanding the interaction between hospital processes on PEDs and patient factors during a pandemic, we are able to anticipate and better allocate future resources.

scholarly journals A Survey to Guide the Emerging Role of Allied Health Teams in a Regional Tertiary Hospital Emergency Department

2020 ◽  
Author(s):  
Bede Ashley ◽  
Tilley Pain ◽  
Heidi Clark ◽  
Ellen O'Connor ◽  
Liana Schnierer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nursing Staff ◽  
Allied Health ◽  
Physician Assistants ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Cross Sectional Survey ◽  
Pharmacy Staff ◽  
Health Team

Purpose: A multidisciplinary allied health team has worked in The Townsville Hospital Emergency Department for seven years. Patients are referred to the allied health team by medical and nursing staff with the aim of reducing patient admission and improving patient outcomes. However, the type and number of referrals received by the allied health team suggest there is a lack of detailed interdisciplinary knowledge by the referrers. Therefore, the Emergency Department Allied Health Team surveyed other emergency department health professionals to ascertain their knowledge of allied health roles. The results will be used to develop education sessions to fill gaps in knowledge. Methods: A cross-sectional survey consisting of 22 true/false statements and demographic questions was developed by the Emergency Department Allied Health Team. Questions described some of the common triggers for referral to physiotherapy, occupational therapy, social work, and pharmacy staff in the emergency department at the Townsville Hospital. The survey was distributed opportunistically to nursing, medical and physician assistant staff at handover or education sessions. Descriptive statistics were used to describe the data and comparisons used chi squared tests. Results: The response rate for the survey was 63% (n=154), including 52 doctors (65%), 95 (59%) nursing staff, 3 physician assistants (100%), and 4 who did not state their discipline. Preferred responses were low for questions about occupational therapy’s ability to do home visits up to four weeks post emergency department discharge (37.7%), physiotherapists’ necessity to perform mobility assessments (24.7%), identifying APINCH acronym as mnemonic for high risk drugs (35.7%) and the correct application of “close the gap” prescriptions (27.9%). Staff with more experience and prescribers were more likely to give the preferred response. Conclusions: Some gaps exist in doctors’, nurses’, and physician assistants’ knowledge of the roles of allied health in an emergency department. The knowledge gap decreases as staff experience in emergency departments increases. Therefore, for the allied health team in our emergency department to work at full scope of practice, these knowledge gaps need to be addressed. Our challenge now is to provide sustainable education on the role of allied health in a busy emergency department full of shift working and rotating staff being pulled by a myriad of contrasting priorities.

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