The Emergence of the Physician Assistant Role in a Canadian Acute Care Surgery Setting

Authors:  Andrea Lack, HB.Sc. (Physician Assistant), CCPA; Marlie Valencia, BHSc; Dr. Rahima Nenshi, MD, MSc, FRCSC

Purpose:  This article will focus on the emergence of the Physician Assistant (PA) role in an Acute Care Surgery (ACS) Team within a Canadian academic tertiary care hospital.  The PA role was established on the ACS team of this academic hospital in November 2014.  
 
Methods:  To quantify the involvement of the PA, we have created an ACS database starting in September 2016 and data collection is ongoing. Data is collected on a daily basis regarding the following information:  Total Patient Encounters, Total Surgical Consults, Total ACS Admissions, Total ORs, Total PA patient encounters, Total Family Meetings, and Total Multi-disciplinary Meetings. This project aims to define the role of a PA on an ACS team within an academic tertiary care centre. This project will also serve as a method of quantifying the involvement of the PA role in a particular healthcare setting, which may be used to help the emergence of the PA role throughout the Canadian healthcare system.

Results: The ACS team is responsible for a mean of 33.5 patient encounters per day (Range 22-48), with a total of 6600 patient encounters in the six and a half month study period to date.  The mean for total consults in a day was 6 (Range 1-16). Total surgeries performed in a week had a mean of 14, with a mean of 2.5 surgeries per day.  The PA currently works daytime hours only, (7am to 3pm, Monday to Friday).  This equates to 24% of the total working hours in a week. In the study period the PA actually worked 22% of the working hours when you also account for holidays. Despite this, the PA was directly involved in 57% of the total patient encounters. Multidisciplinary meetings were conducted by the PA 97% of the time.  Family meetings were conducted or attended by the PA 80% of the time.  Alternate Level of Care (ALC) patients were seen by the PA 95% of the time.  The PA was directly involved in only 2.9% of the total ORs in the study period.

Discussion: The integration of the PA on the ACS team of this busy academic hospital has been valuable to patient care and consistency of care.  It has also been instrumental with the additional availability of daytime OR access, which has allowed for more timely access to health care professionals and improvement to overall patient care.   Despite working daytime hours only, the PA has been directly involved in 57% of patient encounters, 95% of encounters with patients with lengthy hospital stays and 97% and 80% of multidisciplinary and family meetings respectively.  In turn, the PA has been able to effectively manage the team while the staff surgeon and surgical residents are operating, performing other procedures such as endoscopy or involved in academic training.  With appropriate communication and knowledge of patient plans, the PA is able to implement patient health care in a timely manner.  This allows for more accessibility and consistency of care and less handover.