Physician assistants making significant contribution to Emergency Department teams in Ontario

Since joining the Emergency Department (ED) at Ross Memorial Hospital in Lindsay, Ontario, in October 2009, Physician Assistant (PA) Robert McDougall has had a major impact on patient care.

As a PA, Robert is trained to support physicians in a range of health-care settings. PAs have practised for many years in the Canadian Forces, and have practised in the U.S. since the 1960s. Now they are being introduced in Ontario.

While Ross Memorial implemented some initiatives to streamline case management, the most significant and consistent performance improvements are seen on the shifts that Robert staffs. He sees, on average, 110 patients per week. Data indicate that in May 2010 a total of 3,566 hours of waiting time was saved, and Ross Memorial’s Left Without Being Seen (LWBS) rate dropped down to 2 per cent from about 6 per cent in 2009.

After retiring as a PA from the Canadian Forces, Robert joined Ross Memorial, which is one of 19 sites participating in the Ontario Physician Assistant Initiative’s Emergency Department demonstration project. The goal of this demonstration project, one of several underway, is to reduce wait times and maintain full emergency service coverage.

“It’s what I expected and then some,” he says of joining the team, noting that the staff has embraced him and the team is stronger than ever. PAs in the project, such as Robert, are guided by medical directives, a document that defines a PA’s scope of practice, and a competency profile. They work under the supervision of a physician.

Robert’s supervising physician, Dr. Dawn Reid, says she is “extremely happy” with Robert’s impact on the service the team is able to provide patients. “His experience as a PA in the Canadian military enables him to assist with the care and disposition of less complex patients. These patients account for roughly 50 per cent of visits to the emergency department every day.”

The PA initiative is being co-led by the Ministry of Health and Long-Term Care and the Ontario Medical Association. PAs are working at hospitals, community health centres, diabetes clinics, long-term care settings, EDs, and family health teams.

“The Ontario Hospital Association (OHA) fully supports the PA initiative and will continue supporting its work as a model to expand care,” says Tom Closson, President and CEO of the OHA, which manages the hospital demonstration projects. “To date, the PA initiative has shown results in expanding the ability of our health-care system to deliver quality care for patients.”

PAs currently participating in two-year demonstration projects include retired graduates of the Canadian Forces Physician Assistant education program, PAs educated and certified in the U.S. and selected International Medical Graduates. With the launch of two PA education programs, one run by McMaster University and the other by a consortium of the University of Toronto, the Michener Institute, and the Northern Ontario School of Medicine, Ontario will soon be graduating “homegrown” PAs.

At Sunnybrook Health Sciences Centre, PA and Sudbury native Zlata Janicijevic brought welcome experience in cardiothoracic surgery and emergency medicine from the U.S. to the team.

“PAs are trained in the medical model,” explains Zlata, who joined the hospital in November 2009. “We are the physician’s right-hand person. We see patients, do histories and physicals, order labs tests and imaging, interpret results, discuss each patient with our supervising physician, and make a plan.” The response from patients has been overwhelmingly positive, she says.

Dr. Paul Hawkins, Zlata’s supervising physician, says Zlata has very capably met Sunnybrook’s needs, which includes a focus on the academic – she is on the faculty at the University of Toronto PA program ­­and – and adapting to the ED physician scope of practice. “She has good experience, is critically care sensitive, and talented. She helps with flow, sees lots of patients, gets them seen quickly, and gets tests done more quickly,” he says.

Zlata sees Canadian Triage Acuity Scale (CTAS) 1-5 patients regularly, which can range from emergent to non-emergent cases that could involve acute abdominal pain or chest pain, shortness of breath, stroke symptoms, back pain, broken bones, and simple lacerations. She is also part of the resuscitation team, capable of central line placement and chest tube placement. She estimates that her being on the team results in an up to 60 per cent increase in the number of patients seen in a given zone per shift.

“Everyone has been great in welcoming me to Sunnybrook and happy to have an addition to the team to help with patient care and improve flow,” says Zlata. “I think the nurses especially appreciate the fact they can come to me to discuss cases, and I can help facilitate orders, treatment, and disposition.”

While data is being collected about the contribution of PAs to the health-care system, early indicators suggest that these PAs are having a positive impact.

The PA project is part of the government’s strategy to ensure that Ontario has the right number and mix of health-care providers, when and where they are needed. PAs are working to provide timely access to health-care services for all Ontarians and are moving towards achieving the goal of improved patient care, quality, and satisfaction.

For further information about the PA role, please refer to www.healthforceontario/ca/pa.