Physician associates - A new way of delivering of healthcare in the Emergency Department

Objective: Physician Associates were employed in a busy London Emergency Department to provide a new level of integrated Emergency Medical care. Background: Physician Associates have proved invaluable in the USA medical field over the past 30 years and have been identified as a possible workforce solution in the UK1,2. There are currently 19 Physician Associates (PAs) working in Emergency Departments across the UK3, with the aim of improving the ED staffing crisis. Case Description: Two Physician Associates were employed in a London Emergency Department 18 months ago, initially to assist in the Observation ward previously run by locum SHO's. As well as providing permanent, reliable junior staff members, this also alleviated the expenditure on locums in the Observation Ward at approximately half the cost per year. Despite initial skepticism, the role has developed following structured teaching sessions and reliable support from a designated consultant. A vigorous appraisal system was instigated with the clinical supervisor to ensure that the PAs’ clinical skills were developing appropriately and the PA's now see new unselected patients in the ED. The PAs also contribute to achieving CQUIN targets within the department by completing VTE assessments and discharge summaries. All patients in the observation ward now receive a senior review by either a Consultant or Registrar within 12 hours of admission - improving patient outcome. Research shows that patients do not mind whether they are seen by a PA4 and the role has been well received. Conclusion: PAs have been so well received in the department that there has been a proposal to employ further individuals as a workforce solution. Doctors who work regularly with PAs are pleased with the role5. This model could be used in other hospitals to help with staffing pressures and also reduce cost of employing locums.