The impact of adding a physician assistant to a rural community hospital intensive care unit
Adding a PA to a rural Community ICU
DOI:
https://doi.org/10.5203/jcanpa.v2i6.873Keywords:
PAs or physician assistants, Canada, ontario, community care hospital, intensive care unitsAbstract
Physician Assistants (PAs) are being used to enhance service delivery in a variety of practice settings. This study investigated the impact of adding a physician assistant to an internist team covering a rural community hospital Intensive Care Unit (ICU) in North East Ontario. Retrospective chart reviews and CIHI data extraction was done on a cohort of ICU patients prior to the hiring of a PA (no PA) and compared to a cohort of ICU patients who had received care from a PA during their ICU stay. Inverse probability of treatment propensity scores were applied to match a no PA cohort (n=136) to a PA cohort (n=132). Cohorts were matched to gender, age, comorbidity, and diagnostic groups. The use of a PA was associated with a trend towards lower mortality (42% vs 27%, p<0.07) and no difference in readmission rates or resource intensity. Post PA patients had greater lengths of CCU and hospital stay (19 hrs, p<0.002; 2 days, p<0.002) and more complete admission notes (p<0.003). Adding a PA was associated with greater CCU and hospital length of stay, more complete admission notes and a trend towards improved mortality.
References
Austin, P. e. (2015). Moving towards best practice when using inverse probability of treatment weighting (IPTW) using a proprensity score to estimate causal treatment effects in observational studies. Statistics in Medicine, 34, 3661-3679.
Bohm, E. e. (2010). Experience with physician assistants in a Canadian arthroplasty program. Can J Surg, 53(2), 103-8.
Costa, D. e. (2014). Nurse practitioner/physician assistant staffing and critical care mortality. Chest, 146(6), 1566-1573.
Decloe, M. e. (2015). Improving health care efficiencuy through the integration of a physician assistant into an infectious disease consult service at a large urban community hospital. Can J Infect Dis Med Microbiology, 26(3), 130-32.
Dies, N. (2019). Ontario Physician Assistants. Can Fam Physician, 65(4), 243-345.
Ducharme, J. e. (2009). The impact on patient flow after the integration of nurse practitioners and physician assistants in six Ontario emergency departments. CMEJ, 11, 455-461.
Frechette, D. e. (2016). Insights into the physician assistant program in Canada. JAAPA, 29(7), 35-39.
Garland, A. e. (2013). Staffing in ICUs: physicians and alternate staffing models. Chest, 143(1), 214-221.
Gershengorn, H. e. (2011). Impact of non-physician staffing on outcomes in a medical ICU. Chest, 139(6), 1347-1353.
Gershengorn, H. e. (2016). The impact of adding a physician assistant to a critical care outreach team. PloS One, 11(12), 1-14.
Hamilton, G. e. (2011). Reviewing the evidence for Canada's physician assistant initiative. University of Toronto Medical Journal, 88-90.
Hiza, E. e. (2015). Effect of a dedicated orthopaedic advanced practice porvider in level 1 trauma center. J Orthop Trauma, 29(7), e225-e230.
Jones, J. e. (2012). Where the Canadian physician assistants are in 2012? JAAP, 25, e54-e57.
Kawar, F. e. (2011). MICU care delivered by PAs vs Residents:do PAs measure up. JAAPA, 24, 36-41.
Klienpell, R. e. (2008). Nurse practitioners and physician assistants in the intensive care unit: an evidence-based revie. Critical Care Medicine, 36(10), 2888-2897.
Matsushima, K. e. (2016). A high-volume trauma intensive care unit can be successfully staffed by advanced practitioners at night. Journal of Critical Care, 33(4), 1-11.
Messing, J. e. (2016). Optimizing the integration of advanced practitioners in trauma and critical care. J Trauma Acute Care Surg, 83(1), 190-196.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Donald Fung, MD, Joseph Caswell, Ph.D., Tanya James, Gavan Harmen, MD, Kerry Reed, MD, Michael Conlon, Ph.D, Venessa Charette
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors published in the Journal of Canada's Physician Assistants (JCanPA) retain copyright of their articles, including all drafts and final published version. By agreeing to publish in JCanPA, authors grant the journal the right of first publication and distribution rights of the articles. Authors are free to submit their work to other publications in addition to JCanPA, provided they acknowledge its initial publication in JCanPA.
JCanPA is published online in the public domain. JCanPA holds no legal responsibility as to how these materials are used by the public. Please ensure all authors, co-authors, and investigators have read and agree to these terms.
