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Physician Assistant Management of Pediatric Patients in a General Community Emergency Department: A Real-World
Daniel Pavlik1, Alfred Sacchetti, Amanda Seymour
1From the *Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ; †College of Health Sciences, Arcadia University, Glenside; and ‡Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Insights
Physician assistants (PAs) provide comparable care to young pediatric patients in the emergency department (ED) as attending emergency physicians (EPs). A study found similar 72-hour recidivism rates between PAs and EPs managing children aged six and younger.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Healthcare Quality
Background:
- Physician assistants (PAs) play a significant role in emergency department (ED) settings.
- Previous research has focused on the nonclinical aspects of PA practice in the ED.
- The clinical effectiveness of PAs in managing pediatric patients requires further investigation.
Purpose of the Study:
- To evaluate the clinical care provided by physician assistants (PAs) to pediatric patients aged six years or younger in a community emergency department (ED).
- To compare the outcomes of care for young pediatric patients managed by PAs versus attending emergency physicians (EPs).
Main Methods:
- Retrospective analysis of electronic medical records for pediatric patients aged six years or younger in an urban community ED.
- Comparison of 72-hour recidivism rates as an objective outcome measure.
- Analysis of three care groups: EPs alone, PAs alone, and PAs with EP consults (PA & EP).
Main Results:
- A total of 10,369 pediatric patients were included in the study.
- The overall 72-hour recidivism rate was 7.8%, with 0.55% requiring subsequent admission.
- Recidivism rates were: PA (6.8%), EP (8.0%), and PA & EP (9.3%) (P < 0.03). Admission rates did not significantly differ between groups.
Conclusions:
- Physician assistant management of pediatric patients aged six years or younger demonstrates similar 72-hour recidivism rates compared to attending emergency physicians.
- The findings support the efficacy of PAs in providing clinical care to young pediatric patients in the ED setting.
Purpose:
Multiple studies have documented the nonclinical characteristics of physician assistant (PA) practices in the emergency department (ED). This study examines the clinical care PAs provide to younger pediatric patients in a general community ED.
Methods:
The electronic medical record database of an urban community general ED was queried to identify pediatric patients aged 6 years or younger. This age group was selected because it was considered to be representative of physiologic and pathologic conditions unique to children. The 72-hour recidivism rates were used as an objective outcome measure to compare the care provided by PAs with the care of attending emergency physicians (EPs). Three different treatment groups were defined for the analysis: EPs alone, PAs alone, and PAs with consults from EPs (PA & EP).
Results:
A total of 10,369 children aged 6 years or younger were seen during a 24-month study period. The mean (SD) age of the patients was 2.2 (0.2) years, with 2909 (28%) aged 1 year or younger. A total of 807 (7.8%) patients returned within 72 hours of their initial ED visit with 57 (0.55%) subsequently admitted. Recidivism rates for the 3 clinical groups were as follows: PA (6.8%), EP (8.0%), and PA & EP (9.3%) (P < 0.03). Patients admitted to the hospital on their return visits for the 3 clinical groups were as follows: PA (0.4%), EP (0.6%), and PA & EP (0.7%) (P = 0.2).
Conclusions:
Based on the outcome measure of 72-hour recidivism, PA management of pediatric patients 6 years or younger is similar to that of attending EPs.
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