Background: Role of physician assistants (PA) is well established in United States healthcare system. Hospitalist teams are utilizing PA services in various roles and in many different capacities. Demand of hospitalists is constantly increasing and there are not enough hospitalists to meet the demand. In academic medical centers resident’s duty hour restrictions and regulations have further widened the gap. PA’s are often employed to bridge the gap and are required to provide a high level of clinical care to complicated hospitalized patients. There is not enough literature available to establish the quality of care as well as patient safety provided by PA’s in tertiary care hospitals.
Purpose: The purpose of study is to compare patient safety and quality of care provided by physician assistant (PA) team to Internal Medicine resident’s team
Description: Procedure:Internal Medicine has two units, UNIT 1 & UNIT2, on same floor at University Hospital, Columbia, Missouri. Both units have similar level of care. Both units have same management, nursing staff, care managers and other ancillary staff. Unit 1 was assigned to internal medicine resident’s team and unit 2 was assigned to PA team.
TEAM COMPOSITION:
RESIDENT’S TEAM: 1 attending Hospitalist, senior resident, 2 interns, 2-3 medical students
PHYSICIAN ASSISTANT (PA) TEAM: 1 attending hospitalist, physician assistant, PA fellow or MD fellow, 1-3 physician assistant students.
Following measures were calculated for 6 months from July to December 2017.
1- HCAPS score and percentile rank on NRC health reports.
2- Re-admission rate after 30 days
3- Hospital acquired complications including CAUTI, HCAP, CLABSI, CDAD etc
4- Average length of stay
5- Medicine unit discharge orders entered in EMR
6- Electronic notification of 24 hour prior to discharge
7- Employee engagement: Medical staff, mid-level providers and hospitalist physician survey before and after intervention.
RESULTS:
• Patient experience/ NRC health report trends continue to show upward trend in percentile ranking from 62.3 in first quarter to 80.0 in fourth quarters.
• 30-day re-admission rate was better in PA TEAM UNIT 2 (11.02%) as compared to IM RESIDENT UNIT 1 (13.24%)
• Average Length of stay (LOS) was equal in both units.
• Medicine unit discharge orders entered in EMR before noon were significantly high (68%) in PA TEAM UNIT 2 as compared to IM RESIDENTUNIT 1 (48%)
• Electronic notification of 24 hour prior to discharge was significantly high (42%) in intervention unit as compared to IM RESIDENT UNIT 1 (12%)
• Medical staff, mid-level providers and hospitalist physician preferred PA TEAM UNIT 2 over IM RESIDENT UNIT 1 on study surveys.
Conclusions: Care provided by physician assistant team is not inferior to internal medicine team in tertiary care academic medical center.
