• Supporting doctors to help expedite patient care • Ensuring high quality and timely care • Examining effectiveness one year on Benjamin Close Director Emergency Townsville Hospital, QLD

1. Physician Assistants in the ED
Dr Ben Close – ED Director
The Townsville Hospital Emergency Department
Healthcare Improvement Unit, Department of Health

2. What is a Physician Assistant (PA)
• Mature, experienced Health professional
• Trained in the Medical Model
• Direct/Indirect/Remote Supervision
• Tasks, including but not limited to;
– Patient history & physical examination,
– Procedures e.g. IVC, suturing
– Ordering pathology & imaging
– Prescribing medications & fluids

3. History
• Originated in the USA in the 1960’s
• Currently 108,500 PA’s certified in the
USA
• Up to 20% of this group work in ED
• 77% of ED’s use them (2006 data)
• National certification (NCCPA) that
individual states rely on for
licensure/regulation requirements
• Specialty qualification program added in
2009

4. Role in US ED’s
• Majority used in Fast Track models of
care
• Triage
• Trauma
• Administration
• Rural

5. How are PA’s Trained
• Pathway to PA; Pre-Hospital Care, Nursing,
Military, Allied Health i.e. Pharmacy,
Physiotherapy, Podiatry
• University of Queensland – Masters Degree
• James Cook University – Bachelors degree (3
years)

6. How are PA’s employed
• QLD Health – Clinical Governance
Guideline 16Oct14
• QLD Health (Drugs and Poisons)
Regulation 1996 – 01Oct15
• Hospital & Health Service PA Practice
Plan
• Townsville Hospital – Senior Intervention
From Triage (SIFT) model

7. 40 0
17th March 2016

8. The Townsville Hospital
• Tertiary trauma hospital for North Queensland
• Adults & Paediatrics
• Inter-hospital transfers (no advanced burns care
or organ transplant)
• > 580 beds
• 78,000 ED presentations last year
• NEAT 88%

9. The Townsville Hospital
• PA trial commenced in March 2015
• 3 Physician Assistants
• PO4 $93,298 p.a.
• Aim was to use the PA’s in a senior
medical driven, front loaded model to
target at risk patients

10. SIFT at TTH ED
• Senior Intervention From Triage (SIFT)
• 1000 to 2230 7 days a week
• Team
– Emergency Physician, Registrar, PA and often a RN
• Role
– Early intervention to improve outcome and speed up
pt journey
– Dynamic role, targeted higher risk or disadvantaged
groups
– Surge capacity & mobile response

11. SIFT at TTH ED
• 53 year old male
• ‘Severe L sided abdominal pain, 10/10, can’t get comfortable,
blood in urine, on irbesarten for high BP’
• PA picks up patient immediately after triage
• Inserts 18G IV cannula
• Administers IV morphine
• Sends FBC, E/LFT, Lipase
• Takes history, examines patient
• Confirms frank haematuria on WTU
• Discusses case with FACEM
• CT KUB ordered
• Patient admitted to the SSU on regular analgesia to await CT
• Adds clinical notes on eMR

12. Progress
• Audits
• Medical imaging & pathology requests,
medication prescribing and medical
record entries
• Patient Satisfaction Survey
• Medical feedback
• Staff feedback

13. Average
waiting times
(min)
Admitted
NEAT (%)
Discharged
NEAT (%)
Did Not Wait
(%)
Left after
treatment
commenced
(%)
ATS3 29 ➤ 24 37 ➤ 70 83 ➤ 94 1 ➤ 0.46 3.3 ➤ 2
ATS4 45 ➤ 36 45 ➤ 76 88 ➤ 96 6.3 ➤ 3.7 1.8 ➤ 1.5

14. • 1466 pathology requests ordered over a 3
month period. ‘No test’ rate in line with the
ED average of 3.83%.
• Random audit against the first time quality
request form mandatory data requirements
for medical imaging. 99-100% (best in ED).
• Random pharmacy prescribing audits.
Standard higher than Dr’s.
• Patient satisfaction survey. 9.4 out of 10
(n=52).

15. Monster 4m crocodile caught on The Strand
in Townsville needs a new home
February 4, 2016

16. Next step
• Prescribing
• Routine medical clearances
• Direct admission pathways
• Inter-hospital transfers
• Model of care changes
• ED specific training
• AHPRA recognition
• Health aligned award system

17. Controversies & Challenges
• Impact on training of medical students &
junior medical staff
• Impact on Nurse Practitioners & other
expanded nursing roles
• Confusion around scope of practice
• Safety
• Cost
• Role substitution

18. Questions?