Hospital Impact—6 ways physician assistants contribute to hospital emergency departments

Doctor and nurses wheeling patient in gurney through hospital corridor
PAs are increasingly assuming administrative and leadership roles in hospital emergency departments. (Getty/Sam Edwards)
Dawn Morton-Rias

As hospitals log millions of emergency department visits each year, they are increasingly turning to certified physician assistants (PA-Cs) to support overburdened emergency medicine teams and improve efficiency.

There are multiple examples of how hospitals are optimizing their use of PA-Cs. For example, UCSF Fresno, a community regional medical center that sees more than 120,000 patients a year and has more than 90 beds in the emergency room, has been expanding its team and now has 16 PAs and NPs staffing its ED.

PAs are increasingly assuming administrative and leadership roles. Emergency medicine PA Fred Wu is program director of UCSF Fresno’s Emergency Medicine PA Residency program. Wu, who has worked in the ED for 13 years, notes that ED PAs help shoulder the pressure, dealing with the increased patient volume in everything from the fevers and flu to heart attacks and traumas such as car accidents. He calls the ED “society’s healthcare safety net”—a large reason that demand continues to grow for emergency medicine PAs in every area from community hospitals to large, thriving health systems.

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Lauren Donaldson, PA-C, typifies emergency department PAs, who in times of high stress—like when there are 30 to 40 patients in the waiting room and physicians are stretched caring for trauma patients—must manage the patient volume. She notes this is when PAs step in to provide services ranging from preparing broken bones to performing procedures like lumbar punctures and ordering diagnostics.

Donaldson works in a pediatric ED at Oklahoma University Children’s Hospital, where the patients are often too young to explain their symptoms. She must rely on a wide range of skills to decipher a complex puzzle prior to administering treatment. She cares for children with every type of emergency presentation, including those with injuries from abuse. As a result, her duties also include providing testimony in court when necessary.

Here are six ways emergency medicine PAs are helping EDs reach new levels of clinical and financial success:

1. Drive down costs. With annual compensation for ED physicians approaching $400,000 in some states, per the American College of Emergency Physicians, hospitals are finding that hiring Certified PAs is a cost-effective way to increase clinical bandwidth. According to data (PDF) from the National Commission on Certification of Physician Assistants (NCCPA), the median compensation for PAs who practice in emergency medicine is $115,000. And while annual compensation is higher for some midcareer PAs, their pay remains a fraction of what an ED physician commands. Additionally, PAs can provide critical ED coverage in areas where there are physician shortages, as well as in rural and small hospitals that cannot afford to hire emergency physicians.

2. Treat high acuity patients. In many EDs, Certified PAs perform tasks specific to the needs of higher acuity patients. That includes performing spinal taps to diagnose bacterial infections or bleeding in the brain; placing central lines; managing airways of patients who are critically injured or ill; performing advanced life support for cardiac, trauma and pediatric patients; and undertaking delicate suturing tasks. As such, the physician-PA relationship has grown more collaborative over the years. PAs who work in hospital EDs regularly comment on the mutual relationship with their physician colleagues.

3. Streamline critical ED processes. Hospitals that appoint PAs to triage patients and rearrange ED flow experience significant results. At Adventist Health Feather River Hospital in California, reassigning PAs specifically to triage ED patients cut the rate of patients who left without being seen by approximately 80%, while the waiting time to see a provider was reduced by about half, according to a case study by CEP America. Also, identifying patients who can be moved through quickly and treated without delay allows clinicians more time to spend with sicker patients.

4. Support value-based care practices. As hospitals move to new payment models and take on more risk, it is important to manage patients across the entire care continuum. To that end, PAs help lower length of stay by collaborating with multiple providers, including specialists and ancillary staff, to address all of a patient’s healthcare needs from arrival through discharge. Moreover, PAs often head up efforts to transition patients to different care environments after leaving the ED, ensuring they continue to receive quality care and are not at risk for a return visit or hospital readmission.

5. Spearhead clinical initiatives. PAs also take on many leadership responsibilities in the ED. For example, MedStar Franklin Square Medical Center in Maryland has doubled the number of PAs in its ED in recent years, treating on average nearly 250 patients in a 24-hour period with as many as seven PAs working in the ED at peak hours. Their lead PA, David Hieber, PA-C, has held a variety of leadership roles, including managing a large group of PAs at the medical center, who work in all aspects of the ED. Hieber also helped launch a telemedicine pilot that allowed patients to be triaged and treated more quickly in the ED. The result: A single provider now oversees patient triage in multiple remote hospital EDs at one time. Hieber has also helped systematize other processes, including improving how the organization communicates abnormal lab results after a patient has left the ED.

6. Additional focus on patient engagement. Today, a patient’s top priorities often center on wanting more time to talk to providers about health concerns. PAs can offer additional time to listen and answer questions. They often provide patient and family education, which is crucial in managing care transitions and in reducing hospital readmissions.

PAs usher in a new era of ED efficiency

As the nation’s hospital EDs continue to see about millions of patients per week, successful emergency medicine teams are hiring PAs to not only treat patients but to also make strategic process and clinical changes, as well as take the lead on innovative programs. Hospitals that expand their use of PAs—and allow them to work at the top of their license—can expect to improve patient flow, reduce physician stress, and spend more time treating the most critically ill and injured patients.

Dawn Morton-Rias, Ed.D., PA-C, is the president and CEO of the National Commission on Certification of Physician Assistants.