Indirect Patient Care Research Articles

Modeling nurse-patient assignments considering patient acuity and travel distance metrics

Balancing workload among nurses on a hospital unit is important for the satisfaction and safety of nurses and patients. To balance nurse workloads, direct patient care activities, indirect patient care activities, and non-patient care activities that occur throughout a shift must be considered. The layout of a hospital unit and the location of a nurse’s assigned patients relative to other resources on the unit are also important factors in achieving workload balance. In most hospitals, a unit charge nurse is responsible for the shift assignment of patients to nurses based on experience and past practices. The nurse-patient assignment process is also often a manual process in which the charge nurse must sort through multiple decision criteria in a limited amount of time. In this paper, a methodology for the construction of balanced nurse-patient workload assignments is proposed. Through the illustration of this methodology new scoring metrics are developed using measures currently available on, or from, the hospital unit. It was demonstrated that the complex scheduling problem can be captured. While the methodology was illustrated for a scheduling problem commonly encountered on a hospital unit, the approach can be adapted to other workforce scheduling problems in which measures of workload are required and composed of elements imposed by the work environment, variability within the required tasks, and a measurable perception of the relative intensity of the work elements.

The use of volunteers to help older medical patients mobilise in hospital: a systematic review.

To review current evidence for the use of volunteers to mobilise older acute medical in-patients. Immobility in hospital is associated with poor healthcare outcomes in older people, but maintaining mobility is frequently compromised due to time pressures experienced by clinical staff. Volunteers are established in many hospitals, usually involved in indirect patient care. Recent evidence suggests that trained mealtime volunteers had a positive impact on patients and hospital staff. It is unclear whether volunteers can help older inpatients to mobilise. Systematic review. We searched Cochrane, Medline, Embase, CINAHL, AMED and Google databases using MeSH headings and keywords within six key themes: inpatients, older, mobility/exercise, delirium, falls and volunteers. Full texts of relevant articles were retrieved and reference lists reviewed. Of the 2428 articles that were identified, two scientific studies and three reports on quality improvement initiatives were included in the final review. One study included volunteer assisted mobilisation as part of a delirium prevention intervention (HELP). The second study has not reported yet (MOVE ON). The contribution of volunteers in both is unclear. Three quality improvement initiatives trained volunteers to help mobilise patients. They were not formally evaluated but report positive effects of the volunteers on patient and staff satisfaction. This review has identified a lack of scientific evidence for the use of volunteers in mobilising older medical inpatients, but quality improvement initiatives suggest that volunteers can be employed in this role with reports of staff and patient satisfaction: this is an area for further development and evaluation. This review outlines the evidence for the involvement of volunteers in maintaining patients' mobility, identifies mobilisation protocols that have been used, the need to train volunteers and for formal evaluation of volunteers in this role. Prospero registration number: CRD42014010388.

Commentaries on health services research

Commentaries on health services research

Preparation of academic nurse educators

Nursing practice is diverse, with nurses serving in both direct and indirect patient care roles. For nurse educators, the realm of nursing practice extends beyond direct patient care to include preparing students for nursing practice. Academic nurse educators must be prepared to serve as educators, researchers, and to have experience in a clinical specialty area. For many nurse educators, advanced academic preparation often relates to a clinical area of practice rather than pedagogical practice. Graduate-level knowledge of evidence-based research and practice, teaching methods, and curriculum design and development form the foundation for academic practice. Because education and nursing are two distinctive disciplines, clinical expertise does not naturally result in teaching expertise. Lack of consensus regarding the educational preparation of nurse educators adds to the complexity of the nursing profession. The purpose of this article is to advocate for pedagogical preparation for academic nurse educators. Additionally, this article contains recommendations for pedagogical competencies indicative of academic nurse educator preparation.

A Time Study of Plastic Surgery Residents.

Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P < 0.0001); 57.7% of activities require 4 minutes or less, suggesting that resident work was highly fragmented. Residents spent 10.7% of their workdays waiting for other services. In this first-time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we suggest that future changes to residency programs be pilot tested, with preimplantation and postimplementation time studies performed to quantify the changes' impact.

Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands

Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.

Practice patterns and organizational commitment of inpatient nurse practitioners.

Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NP's workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers.

Impact of working 48 h per week on opportunities for training and patient contact: the experience of Irish interns.

The European Working Time Regulations (EWTR) have been criticized for its purported negative impact on the training of junior doctors. The aim of this study was to examine the amount of time interns spent engaging in various work activities. An online time-use diary was used to collect data from interns. Two teaching hospitals in the Republic of Ireland. A total of 45 interns logged at least one 24-h period. The logs were obtained from 67 shifts from a surgical rotation and 83 shifts from a medical rotation. The amount of time interns spent engaging in direct patient care, indirect patient care, educational activities and personal activities. On day shift, medical interns spent a significantly smaller proportion of the shift on direct care (159/613 min, 25.9% versus 214/636 min, 33.6%) and a greater proportion on education (195/613 min, 31.8% versus 139/636 min, 21.9%) than surgical interns. On extended days, medical interns spent a significantly larger proportion of the shift on education than surgical interns (243/814 min, 29.9% versus 126/804, 15.7% min). On night shift, medical interns spent a significantly greater proportion of the shift on direct care (590/720 min, 81.9% versus 346/727 min, 47.6%) and education (33/720 min, 4.6% versus 6/727 min, 0.8%) than surgical interns. The interns in the study reported spending more time on direct patient care and educational activities, and less time on indirect patient care activities than interns in other countries.

The physician assistant hospitalist: a time-motion study

Objective: The role of hospital-based physician assistants (PAs) is in need of delineation. To learn more about their activities, an administrative research project compared the tasks of hospitalists. In this setting an MD-PA team managed the adult medicine ward each weekday while three MDs rotated shifts.Methods: A priori a survey of hospitalist activities was administered to four providers in a medium sized hospital (3 MDs and 1 PA). This was followed by time-motion documentation that involved shadowing each member of the MD-PA hospitalist teams over a three-month period. A univariate analysis of activity patterns (perceived and observed) assessed what was perceived and what actually occurred on the wards. The mean, standard deviation, and difference in means for each task were calculated.Results: In the survey the PA reported she spent one-half of her hospitalist workdays on direct patient care and the physicians spent less time on direct patient care. Physicians believed they spent half days on direct patient care and believed the PA spent less time on direct patient care than they did. In the time-motion study shadowing the four hospitalists separately what was observed was that the PA spent 18% of her workday on direct patient care and 54% on indirect patient care - primarily patient encounter documentation. The three physicians spent 15% of their workday on direct patient care and 54% on indirect patient care – primarily patient encounter documentation. In summary, the perception of what each provider thought they did and what they in fact did differed significantly when actually observed. All four hospitalists (regardless of team composition) spent less than 20% of their workday with patients, and the rest divided among documentation, examination and test results, hospital meetings, and breaks. Task activity was similar for all providers except MDs attended more administrative meetings than the PA.Conclusions: The perception that physicians have of PA roles and what a PA actually does has been a reoccurring observation. A lack of understanding of PA role delineation by physicians may contribute to employment reluctance.

THE BC INHERITED ARRHYTHMIA PROGRAM: A MULTIDISCIPLINARY APPROACH TO FAMILIES AT RISK FOR SUDDEN DEATH

INTRODUCTION: Inherited arrhythmia (IA) disorders predispose to syncope, sudden cardiac arrest (SCA) and sudden death. Establishing a diagnosis is critical to implementing treatment and enabling cascade screening of at risk family members. An expert, multidisciplinary approach to this patient population is a guideline-based recommendation. The BC Inherited Arrhythmia Program (BCIAP) combines the expertise of cardiology and medical genetics in a provincial, multi-site, family-centered program targeting at risk patients and family members. Launched in April 2013; 400 referrals were expected in the first year, with 38 multidisciplinary clinics planned. METHODS: The BCIAP assesses patients and first-degree relatives for IA, SCA, and history of familial sudden death. An adult electrophysiologist (EP), genetic counsellor and research nurse attend patient evaluations. Families with children under 18 attend clinics that also include a pediatric EP and nurse. Medical Geneticists provide indirect patient care and case review. Patients undergo clinical assessment, investigations, and genetic counselling. Consent to contact for research is sought for all; the majority of patients in the Vancouver clinic are approached for voluntary research registry participation and bio banking. RESULTS: In the BCIAP’s first year, 576 referrals were received. The most common indication was Long QT syndrome (23%), followed by a family history of sudden death (14%). In total, 209 (46%) of referrals were for a family history indication, and 61 (67% excluding outreach) of the families referred to the program stemmed from cascade screening. Thirty-six multidisciplinary clinics were held at the program’s two main sites, (Vancouver and Victoria); a pediatric EP attended 39%. Additionally, 8 intake and 9 outreach clinics were held in Vancouver and Northern BC respectively. At the program’s two main sites, 398 patients were seen during 343 patient visits; 142 (41%) were family visits. Of families seen, 59% underwent assessment by both adult and pediatric EPs. In patients with available data, 113/398 (28%) underwent genetic testing. Predictive familial mutation testing results are available for 37 patients; 46% tested negative and were discharged. In Vancouver, 317 patients were invited to enrol in research. Of these, 294 provided consent (93%) and are in one or more registry. CONCLUSION: The BCIAP surpassed its target referral numbers and clinics by 44%, emphasizing the need for the service in BC. The number of referrals received for a family history indication and families referred suggests that the BCIAP supports a multidisciplinary family based approach. The potential of research is accepted broadly by this patient population.

Hospital physicians perform five types of work duties in Japan: an observational study.

BackgroundPhysicians are expected to perform three unique roles as a clinician, educator, and researcher in university hospitals. However, the actual practices of physicians performing different duties are relatively unknown. Therefore, the authors conducted an observational study at a university hospital to examine physicians’ work activities.MethodsBetween 2011 and 2013, ten observers shadowed 20 physicians from different specialties for a day at the Tokyo Women’s Medical University Hospital. Observers recorded physicians’ activities every 30 seconds that were subsequently categorized into work types. The number of work types and activity changes performed by a physician in one observational period were counted.ResultsAuthors categorized physicians’ work activities into five groups: patient care (direct and indirect), education, research, professional development, and administration. All physicians performed at least one type of activity in addition to patient care. Activity change occurred 1.86 times per hour, on average. The median time-distribution of 20 physicians was 173.8 minutes, 213.8 minutes, 3.3 minutes, 5.0 minutes, 0 minutes, and 0.8 minutes for direct patient care, indirect patient care, education, research, professional development, and administration, respectively.ConclusionJapanese hospital physicians performed multiple work duties including professional development and administrative activities in addition to triple duties.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-375) contains supplementary material, which is available to authorized users.

Electronic health records and resident workflow: a time-motion study of otolaryngology residents.

To evaluate the impact of electronic health records (EHRs) on the workflow of otolaryngology residents. Prospective, time-motion study. A time-motion study was conducted both in the 2009 to 2010 and 2012 to 2013 postgraduate years. Eight otolaryngology residents were directly observed on both operative and clinic days, with resident activities categorized by way of a database program. Comparisons were made to the same data collected in the same setting prior to and following integration of an EHR system. Residents spent their day on direct patient care (41.1%), indirect patient care (35.3%), didactic education (14.0%), personal activities (6.9%), and transit (3.1%). The primary activity during operative days was direct patient care, and during clinic days it was indirect patient care. Activities of marginal educational value comprised a considerable component of their time (16.5%). Compared to data collected prior to use of an EHR, time was spent similarly. However, residents using an EHR devoted significantly more time to indirect patient care on clinic days (P < .05). This is the first study to evaluate EHR integration on otolaryngology resident workflow. Overall resident efficiency was not significantly altered by the implementation of an EHR. However, more time was shifted from directly caring for patients to documenting on the EHR in the clinic setting. These findings provide an important objective insight into EHRs, especially given the looming mandate for their use and the need to streamline resident curriculum in the duty hours era.

ABSTRACT 963

Background and aims: Nurses can be interrupted during care, which can increase the possibility of human errors and compromise patient safety. Aims: To verify the occurrence of nursing interruptions and to compare frequency and sources of interruptions of intensive care nurses (ICN) and non-intensive care nurses (NICN). Methods: Observational study of 25 nurses (ICN:15;60.0%; NICN:10;40.0%) from a university hospital in Brazil. A classification of nursing activities was accomplished and frequency and sources of interruptions investigated during 150 hours of observation. For statistical analysis t student and chi-square tests were used (p<0.05). Results: A total of 2,295 activities were observed, 1,325 (57.7%) of ICN and 970(42.3%) of NICN. The activities were: indirect patient care (38.6%), direct patient care (22.5%), care management (18.3%), personal activities (10.6%) and unit management (10.0%). Interruptions occurred in 719(31.3%) activities, average of 1.6 interruptions/activity, totaling 1,180 interruptions, 677(57.4%) of ICN and 503(42.6%) of NICN. The main interrupted activity in both groups was indirect patient care (44.7%); ICN experienced 7.5 and NICN 8.4 interruptions/hour (p=0.078). The sources of interruption of ICN and NICN were different (p<0.001); for ICN the medical staff was the main source and the telephone for NICN. The time spent with interruptions was different between groups (p <0.001); to ICN the interruption source with longer resolution time was lack of supplies. Conclusions: ICN and NICN were frequently interrupted, mainly during indirect patient care, and the sources of interruptions and the time spent with them were different for ICN and NICN. Acknowledgements: National Council for Scientific and Technological Development, CNPq:476088/2010-0.

Day‐to‐day activities of clinical dietitians working in the inpatient and outpatient settings in a group of New South Wales public hospitals: The results of a direct observational study

AbstractAimTo describe the daily tasks undertaken by dietitians working within the inpatient and outpatient sectors within the NSW public hospital system.MethodsThis study used an ethnographic methodology that employed a direct, non‐participatory, discontinuous, observational technique to observe hospital dietitians, in both outpatient and inpatient settings, during a typical work shift. Trained volunteer observers collected the data over a three‐year period (2008, 2009 and 2010). The data were combined and then sorted into five categories including: direct patient care, indirect patient care, communication, administration and education of self or others.ResultsA total of 609 hours and 21 minutes were observed across a three‐year time period 2008–2010. On average, the dietitians in both inpatient and outpatient settings spent 18.3–32.2% of their time in direct patient care activities. The majority of time was spent in indirect patient care activities such as: information collection, documentation and discussion with other health‐care professionals. A comparison between the two work settings showed that those dietitians working in the inpatient setting spent less time in direct patient care (18.3% vs 33.1%, P &lt; 0.05), and more time in indirect care activities (41.7% vs 23.3%, P &lt; 0.05) and in communication about patient care (22.7% vs 14.4%, P &lt; 0.05).ConclusionsThe findings show that dietitians spend most of their time doing activities that support patient care, but these activities occur away from the patient.

THE ROLE OF NURSES IN PROVIDING PALLIATIVE CARE FOR DYING CANCER PATIENTS: A META-ETHNOGRAPHIC SYNTHESIS

BackgroundPalliative care is a well-established approach to maintaining quality of life in people with advanced cancer. There is limited research exploring qualified nurses' role when providing palliative care for dying...

Validation of standard times and influencing factors during the development of the Workload Indicator for Nursing

A tool to assist in optimal allocation of available nursing resources is of paramount importance. The goals of this study were as follows: (1) to determine whether the standard time values of the Belgian Nursing Minimum Dataset are a valid basis for the development of a Workload Indicator for Nursing; (2) to quantify the impact of factors that most influence nursing workload; and (3) to examine the cross-impact of items of the Belgian Nursing Minimum Dataset. This research project is a prospective observational study with exploratory aspects. The data for this prospective study were collected during September 2010 from a convenience sample of 23 nursing units in four hospitals in Belgium. The data collection included three parts: (1) the registration of the items of the Belgian Nursing Minimum Dataset; (2) the amount of time committed to direct patient care; and (3) analysis of variables, which influence the nursing workload at patient and unit level. The correlation coefficients for the sum of Direct and Indirect Patient Care and the Workload Indicator for Nursing-score of the surgical, internal medicine and intensive care units were 0·85, 0·88 and 0·89 respectively. Significant differences in standard time utilization for nursing activities at the patient level are directly related to the level of mobility assistance required. Units needing significantly more time for Direct and Indirect Patient Care than predicted by the Workload Indicator for Nursing-score had a higher mean number of complex nursing activities per patient. The high correlation coefficients between the total time utilized for direct patient care and the WiN-score indicate that the standard time values of the Belgian Nursing Minimum Dataset are valid.

Nature and Impact of Interruptions on Clinical Workflow of Medical Residents in the Inpatient Setting

Medical officers (trainees) in their first to third postgraduate years (PGY-1-3s) work in complex, busy environments, performing tasks that require concentration and application of learned skills. There are frequently competing demands, and being paged is among the most common. We quantified and described the effect of interruptions that paging created on the clinical workflow of PGY-1-3s during ward duties. This prospective study was conducted at 2 teaching hospitals in Sydney, Australia. Medical students were recruited as observers to log interruptions of PGY-1-3s' workflow arising from pages from other members of the hospital team. Forty-two pairs consisting of a PGY-1-3 trainee and an observer were recruited, with 24 proceeding to data collection. Nursing was the most frequent source of pages (47%); other medical staff accounted for 16% of pages, allied health for 12%, and others for 24% (with pharmacy the most common). Pages commonly involved direct patient care (46%), followed by medication issues (21%). Tasks interrupted by pages encompassed direct patient care (37%), indirect patient care (15%), and documentation (12%). Only 27% of pages were assessed as appropriate and urgent, while 58% were considered appropriate but not urgent, and 16% were not appropriate. Only 38% of pages were judged to be clinically more important than the task they interrupted. Pages frequently interrupted direct patient care activities for PGY-1-3 trainees, and a significant proportion of pages were identified as either not requiring immediate attention or not appropriate, resulting in potentially avoidable interruptions to clinical workflow. Alternate means of alerting trainees to nonurgent tasks may reduce interruptions and facilitate patient care.

In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?

The 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) common program requirements compress busy inpatient schedules and increase intern supervision. At the same time, interns wrestle with the effects of electronic medical record systems, including documentation needs and availability of an ever-increasing amount of stored patient data. In light of these changes, we conducted a time motion study to determine how internal medicine interns spend their time in the hospital. Descriptive, observational study on inpatient ward rotations at two internal medicine residency programs at large academic medical centers in Baltimore, MD during January, 2012. Twenty-nine interns at the two residency programs. The primary outcome was percent of time spent in direct patient care (talking with and examining patients). Secondary outcomes included percent of time spent in indirect patient care, education, and miscellaneous activities (eating, sleeping, and walking). Results were analyzed using multilevel regression analysis adjusted for clustering at the observer and intern levels. Interns were observed for a total of 873 hours. Interns spent 12 % of their time in direct patient care, 64 % in indirect patient care, 15 % in educational activities, and 9 % in miscellaneous activities. Computer use occupied 40 % of interns' time. There was no significant difference in time spent in these activities between the two sites. Interns today spend a minority of their time directly caring for patients. Compared with interns in time motion studies prior to 2003, interns in our study spent less time in direct patient care and sleeping, and more time talking with other providers and documenting. Reduced work hours in the setting of increasing complexity of medical inpatients, growing volume of patient data, and increased supervision may limit the amount of time interns spend with patients.

Exploring nurse, usage effectiveness of mobile nursing station

A mobile nursing station is an innovative cart that integrates a wireless network, information technology devices, and online charts. In addition to improving clinical work and workflow efficiencies, data is integrated among different information systems and hardware devices to promote patient safety. This study investigated the effectiveness of mobile nursing cart use. We compared different distributions of nursing activity working samples to evaluate the nursing information systems in terms of interface usability and usage outcomes. There were two parts of this study. Part one used work sampling to collect nursing activity data necessary to compare a unit that used a mobile nursing cart (mobile group, n = 18) with another that did not (traditional group, n = 14). Part two applied a nursing information system interface usability questionnaire to survey the mobile unit with nurses who had used a mobile nursing station (including those who had worked in this unit as floating nurses) (n = 30) in order to explore interface usability and effectiveness. We found that using the mobile nursing station information system increased time spent on direct patient care and decreased time spent on indirect patient care and documentation. Results further indicated that participants rated interface usability as high and evaluated usage effectiveness positively. Comments made in the open-ended question section raised several points of concern, including problems / inadequacies related to hardware devices, Internet speed, and printing. This study indicates that using mobile nursing station can improve nursing activity distributions and that nurses hold generally positive attitudes toward mobile nursing station interface usability and usage effectiveness. The authors thus encourage the continued implementation of mobile nursing stations and related studies to further enhance clinical nursing care.

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospital-based PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P > 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well.