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

Quynh Doan, Vikram Sabhaney, Niranjan Kissoon, Sam Sheps and Joel Singer
Department of Pediatrics and 2School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

Abstract
This systematic review describes the role and impact of physician assistants (PAs) in the ED. It includes reports of surveys, retrospective and prospective studies as well as guide- lines and reviews. Seven hundred and twelve studies were identified of which only 66 were included, and many of these studies were limited by methodological quality. Generally the use of PAs in the ED is modest with 13–18% of US EDs having PAs although academic medical centres report PA use in 65–68% of EDs. The evidence indicates that PAs are reliable in assessing certain medical complaints and performing procedures, and are well accepted by ED staff and patients alike. There is limited evidence as to whether PAs improve ED flow or are cost-effective. Future studies on work processes, cost-effectiveness, unfamiliar patients’ willingness to be treated by non-physician providers, and ED physi- cians’ acceptability of PAs are needed to inform and guide the integration of PAs into EDs.

Introduction

As the balance between health-care needs and available resources is constantly challenged, cost-effective alter- natives to training and retaining more physicians are being considered. One such alternative is physician assistants (PAs). PAs are fully licensed medical practi- tioners who are trained to provide care under the direc- tion and supervision of a doctor. Although the doctor is ultimately responsible for the patient and establishes the degree of PA supervision, PAs exercise autonomy in medical decision-making.

There is growing interest in introducing PAs into the health-care system in Australia, Canada and Europe. The use of PAs in EDs is common in the USA, where they are viewed favourably with evidence of high patient satisfaction  and acceptance by other health-care providers.

The Canadian military has also had good experience in using PAs since the 1960s. PAs are now being trained outside the military system in Canada (Manitoba and Ontario) with the hope that they will be integrated into the Canadian health-care system.

Despite their use in Manitoba, and pilot programmes in Ontario, Canada and in Queensland, Australia the PA profession has yet to be fully integrated outside the USA. Their role, scope of practice and contribution to health-care services are not well understood. The purpose of this review is to assess the role of PAs in the ED, their impact on ED efficiency and on patient satisfaction.

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