Surgical Physician Assistants Research Articles

Gaining consensus on a protocol for general surgery physician assistants in the management of non-compressible abdominal haemorrhage in military austere environments: a Delphi study

BackgroundNon-compressible abdominal haemorrhage (NCAH) is a potentially preventable cause of death due to injury. Limited exploratory laparotomy by a non-surgeon is a temporary intervention to sustain life until definitive surgical...

1028: PHARMACOLOGIC INTERVENTIONS ON A SURGICAL INTENSIVE CARE UNIT BY A CLINICAL PHARMACIST

Introduction: Documenting pharmacological interventions in electronic medical record on daily basis can be very time consuming. However, such documentation is extremely important for both quality improvement and cost saving. Methods: A surgical ICU (SICU) clinical pharmacist rounded with the ICU team on the daily basis and documented her pharmacological interventions using Epic ® iVents from January 2021 to June 2022. The SICU had 23 beds, shared by CTICU and Surgical/Trauma ICU. The SICU team included an attending physician (usually a critical care trained trauma surgeon); clinical pharmacist; pharmacy resident; surgical residents; surgical physician assistants; nurses; respiratory therapists; dietitians; and medical school students. Results: The pharmacist documented a total of 3711 ivents in the 18 months. The types of ivents included dosing recommendation (n=1033); initiation of new therapy (n=623); discontinuation of therapy (n= 543); admission medication reconciliation (n=172); recommend lab/test (n=161); therapeutic drug monitoring/kinetics (n=158); iv to po medication switch (n=127); develop medication weaning plans (n=104); duration of therapy (n=81); renew expired medication (n=76); order clarification (n=68); route or formulation change (n=62); restart medication (n=53); antimicrobial de-escalation (n=47); hold medication (n=44); adverse drug event (n=37); high cost drug medication review (n=32); antimicrobial escalation (n=30); restart home medication (n=26); medication rate change (n=22); vancomycin AUC calculation (n=22); clinical drug information (n=17); non-formulation to formulation medication (n=17); VTE prophylaxis initiation (n=17); height and weight verification (n=10); stress ulcer prophylaxis initiation (n=17); drug interaction (n=10); administration time change (n=17); antimicrobial drug-bug mismatch (n=16); restricted medication approval (n=27); and others. Conclusions: The surgical ICU clinical pharmacist was able to document an average of 206 medication interventions in Epic ® per month (ranges: 138 to 296). The highest number of ivents documented occurred in July when new medical house staff started the training. Documenting pharmacist interventions is critical for quality improvement; patient care outcome; and justification for more pharmacist personnel.

Eastern Association for the Surgery of Trauma and Society of Trauma Nurses advanced practitioner position paper: Optimizing the integration of advanced practitioners in trauma and critical care.

Nurse practitioners and physician assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma, the Society of Trauma Nurses, and the American Association of Surgical Physician Assistants acknowledge the value of APs and support their utilization in the management of injured and critically ill patients. This position paper offers insight into the history of, scope of practice for, and opportunities for optimal utilization of APs in trauma, critical care, and acute care surgery services.

Clinical assessment and management of general surgery patients via synchronous telehealth

Objective This paper describes how a clinical team at Landstuhl Regional Medical Center (LRMC) successfully integrated synchronous telehealth (TH) into their routine clinical practice. Methods and materials Synchronous TH encounters were performed using Polycom® software on surgeons’ computers with high-definition (HD) cameras on monitors at distant sites and PolyCom HDX9000® Telehealth Practitioner Carts at originating sites. Patients provided consented and were presented to general surgeons by nurses and medical technicians at Army health clinics throughout the European Theater. Results In calendar year (CY) 2014, five general surgeons and two surgical physician assistants (PAs) at Landstuhl Regional Medical Center along with registered nurses (RNs) at six originating clinic sites throughout Europe completed 130 synchronous TH encounters for 101 general surgery patients resulting in 73 completed and 16 recommended surgeries. Eighty-eight percent of patients had a completed or recommended surgery. No surgeries or procedures planned after initial TH evaluation were cancelled. Originating site clinics ranged in distance from 68 miles to 517 miles. Acceptance by providers, patients and clinic staff was high. Conclusion Synchronous TH was effective and safe in evaluating common general surgical conditions. We excluded sensitive and complex conditions requiring a nuanced physical examination. The TH efforts of the general surgery staff have resulted in high-quality, seamless and predictable TH activities that continue to expand into other surgical and medical specialties beyond general surgery. Seven surgeons and two PAs use synchronous TH regularly serving patients over a broad geographic area.

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A Central Venous Catheter Line Protocol by the Surgical Continuum of Care and Nursing Decreases Line Infection/Complications in All Hospitalized Patients

Background. Central line–associated bloodstream infection (CLABSI) is the third most common nosocomial infection reported from the medical/surgical ICU setting. Rationale. The implementation of a central line protocol using a 3-part checklist would help ensure that all processes related to central line placement are executed for each line placement during the time it is used, thereby leading to improved outcomes. Physician assistants and nurses would be empowered to supervise the checklist and to stop or change the process if warranted. Methods. The intensivists performed a daily needs assessment of all central venous catheters (CVCs) in their respective ICUs. If the CVC was deemed unnecessary it was removed. The Surgical Continuum of Care comprised surgical physician assistants who made daily assessments of all CVCs among non-ICU inpatients. We hypothesized that these physician assistants would expedite the removal of CVCs among non-ICU inpatients. This would lead to a decreased number of central line days, and concomitant decrease in CLABSIs. Data collected were the standard data as used by the National Healthcare Safety Network. Results. From the year 2009 to 2012 the non-ICU lines decreased from 16 499 with a 3.3 CLABSI rate/1000 line days to 12 974 with a 0.85 CLABSI rate/1000 line days. The ICU line days decreased from 8190 with a 3.8 CLABSI rate/1000 line days to 5768 with 0.87 CLABSI rate/1000 line days. Conclusions. The number of CVCs used in the non-ICU patient areas has decreased with a concomitant decrease in CLABSI. The ICUs have seen a decrease in the number of CVC line/days and a concomitant decrease in CLABSI as well. Using a checklist and a clear standard policy in conjunction with a dedicated group of highly trained physician assistants and nurses has lead to a reduction in central line days and a reduction in CLABSI in the critical care areas as well as non-ICU areas.

The Training and Utilization of Surgical Physician Assistants

A community hospital's search for qualified surgical house staff in 1975 led to the development of a postgraduate residency program in surgery for physician assistants. Eleven years after its inception, the program's purpose and structure were reviewed, and its alumni, goals, and contributions were evaluated. A 1987 alumni survey provided data to assess the value of residency training to current employment and job satisfaction.

The Utilization of Surgical Physician Assistants: Policy Implications for the Future

It is anticipated that there will be a major growth in the role of surgical physician assistants in the immediate future. The authors believe that this trend will improve the quality of surgical care in the United States, reduce the number of surgeons being trained, and enable practicing surgeons to be more productive and hence more proficient.

The current and future role of surgical physician assistants. Report of a national survey of surgical chairmen in large U.S. hospitals.

The chairman of departments of surgery in general hospitals with more than 400 beds were surveyed to assess their current and projected use of surgical physician assistants. Of the 552 institutions represented in our survey, surgical physician assistants were working in one-third, providing preoperative, intraoperative, and postoperative care. Two-thirds of the chairmen felt that the introduction of physician assistants had improved surgical patient care in their institutions. In institutions with surgical housestaff, almost half the chairmen felt that surgical physician assistants had improved the quality of residency training. During the next five years an increase of 87% in the number of surgical physician assistants is projected by respondents. We conclude that appropriately trained and supervised surgical physician assistants will play an increasingly important role in improving the care of surgical patients and, by functioning as junior housestaff, make it possible to reduce the number of surgeons being trained.