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Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000451860.95151.e1
Original Research

Forecasting the effect of physician assistants in a pediatric ED

Doan, Quynh MDCM, MHSc, PhD; Hall, William; Shechter, Steven PhD; Kissoon, Niranjan MD; Sheps, Sam MD, MSc; Singer, Joel PhD; Wong, Hubert PhD; Johnson, David MD

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Abstract

Background: Most pediatric ED visits are for nonemergent problems. Physician assistants are well trained to manage these patients; however, their effect on patient flow in a pediatric ED is unknown.

Objectives: To compare the effect on key pediatric ED efficiency indicators of extending physician coverage versus adding PAs with equivalent incremental costs.

Methods: We used discrete event simulation modeling to compare the effect of additional physician coverage versus adding PAs on wait time, length of stay (LOS), and patients leaving without being seen.

Results: Simulation of extended physician coverage reduced wait times, LOS, and rates of leaving without being seen across acuity levels. Adding PAs reduced wait times and LOS for high-acuity visits, and slightly increased the LOS for low-acuity visits.

Conclusions: With restricted autonomy, PAs mainly benefitted the high-acuity patients. Increasing the level of PA autonomy was critical in broadening the effect of PAs to all acuity levels.

© 2014 American Academy of Physician Assistants.

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