The Shock Trauma Center in Baltimore, Maryland, began to utilize certified NPs for discharge rounds and showed no decrease in their efficiency.15 Another Level I trauma center, F.H. “Sammy” Ross Jr. Trauma Center in Charlotte, North Carolina, utilized “midlevel providers” (MLPs) to assist residents by performing tertiary examinations on trauma patients. MLPs were able to identify incidental findings and direct patients to further care.16 Moreover, in a recent study, Dhuper and Choski compared patient outcomes following replacement of medical residents with PAs and hospitalist physicians in a community hospital in New York. They found a statistically significant lower all-cause and case mix index-adjusted mortality following implementation of the PA-hospitalist model.19
Responsibilities of PAs/NPs can be similar to some of the duties of medical and surgical residents. Duties performed by NPs on the trauma service at the University of California, Davis, Medical Center include (but are not limited to) initial evaluation of patients, determining appropriate treatment plans, and planning discharges.6 Riportella and colleagues conducted a nationwide survey of 391 teaching hospitals and learned that these hospitals would continue to utilize PAs/NPs to carry out some of the responsibilities typically carried out by resident physicians. Some hospitals planned to expand the number of PAs/NPs used within their facility.21
Our analysis of duties also indicates that PAs/NPs are performing some invasive procedures previously performed only by physicians. Research supports the effi cacy and safety of having PAs/NPs perform intracranial pressure monitoring22 and chest tube placement.23 As the number of PAs/NPs within the trauma setting continues to grow, it is expected that their duties will expand and responsibilities will increase.
The satisfaction of patients and physicians after PAs/NPs are added to a trauma service has been investigated, with results indicating that hospital staff, attending and consulting physicians, and trauma patients are generally satisfi ed with the care provided by PAs/NPs.13,24-25 Cincinnati Children's Hospital Medical Center, a Level I pediatric trauma center, showed higher satisfaction scores among nurses and patient families with their pediatric NPs when compared to satisfaction with residents.24-25
LIMITATIONS
Results of this survey may be limited by the 53% response rate and the exclusion of smaller trauma centers. PAs and NPs may be utilized differently in lower level acuity trauma centers. In addition, this survey was addressed to hospital directors of trauma services. This position may be held by persons of varied backgrounds who may not be familiar with the full role of PAs/NPs.
CONCLUSIONS
Approximately one-third of responding trauma facilities (both Level I and Level II) reported utilizing PAs/NPs on their trauma service, with the majority being verifi ed by the ACS. This indicates that the staffi ng model utilizing PAs/ NPs providing direct care to the trauma patient (with or without surgical residents) has been accepted by the highest accrediting program as well as by established trauma care organizations. This reported use of PAs/NPs in direct care of trauma patients indicates a reasonable solution for staffing trauma centers.
While the majority of reporting trauma centers are utilizing PAs/NPs to complete traditional duties (histories and physical examinations, resuscitation, and discharge summaries), many of these centers are also utilizing PAs/NPs to perform invasive procedures that were previously performed exclusively by physicians.
Of those reporting trauma centers not currently employing PAs or NPs in trauma service, 19% indicate the potential for utilization of them in the future. This highlights the potential for continued job growth for PAs/NPs in US trauma centers. Finally, this evaluation of the utilization of PAs/NPs in direct care to trauma patients indicates the acceptance of PAs/NPs in trauma staffing models. JAAPA
The authors are from Wichita, Kansas. Sue Nyberg is Associate Professor and Chair, Department of Physician Assistant, Wichita State University. Kayla Keuter practices in the Department of Trauma, Wesley Medical Center. Gina Berg is Research Assistant Professor, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine. Amy Helton practices at Cardiovascular Consultants of Kansas, Inc. Angela Johnston works in family practice at Spectrum Family Medical Clinic. The authors have indicated no relationships to disclose relating to the content of this article.
Acknowledgment: The authors would like to thank Wesley Medical Center Trauma Department for fi nancial support with administration of the survey.
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