The Expanding Role and Bright Future of Advanced Practice Practitioners in the Emergency Department

Advanced Practice Practitioners see a wide variety of patients at our hospital sites, from those with chest pain to those with minor lacerations and everything in between.

This practice is not limited to us. Nationally, it is estimated that Physician Assistants (PA’s) see 10 percent of emergency room patients in the United States, and a 2009 survey from ACEP shows their use has increased in recent years. 

The number of physicians who reported supervising PA’s increased 12 percentage points from 64.7% to 76.7%, the survey also showed. There was also an increase in the percentage of respondents who felt that PA’s decreased wait times (85.2%-91%) and improved patient satisfaction (65.2%-75.4%).

With emergency department (ED) volume increasing 32% from 1996-2006, it’s easy to see why the numbers of PA’s in the ED have increased as well. In addition, as ED crowding and throughput continue to be a challenge, APPs are allowing physicians to spend more time at the bedside of patients, which improves patient satisfaction and safety.

This trend will hopefully lead to a decrease in malpractice liability, although the ACEP survey showed that physician attitudes regarding PAs and malpractice risk have not changed much over the last 5 years. In 2004, respondents said they thought PAs were more likely to commit malpractice than emergency physicians by a margin of 28.4% vs. 15.7%. In 2009, respondents to the same questions said both groups were slightly more likely to be sued.

The survey also showed that the more years a PA had worked with a physician, the less risk (perceived) there was of having the PA around. This means that while many emergency physicians may fear they are exposing themselves to more liability by supervising a PA, that fear may be largely unfounded.

Data from the National Practitioner Data Bank suggests that PAs actually decrease medical malpractice risk. In the ED, APPs offer a golden opportunity to allow physicians to decrease risk, improve throughput and spend more time at the bedside; however, this benefit can only be achieved with hard work by both the emergency practice and the APP.

We believe our APPs are some of the best in the business and strive hard to continue to improve their performance. We look for PAs with good experience in emergency medicine who have completed post-graduate residency in emergency medicine, and then gives them the right supervision.

We focus on each of these elements independently to hire and support excellence emergency medicine APPs. And through selective recruiting and productivity based compensation, we attract the best qualified candidates. Well established quality measures such as Peer Review, mentoring and annual reviews are used to enhance indirect supervision as well. Finally, the APP educational program is a robust curriculum consisting of semi-annual, two-day off-site conferences, monthly online lectures and observed patient simulations.