The good news is we can bring this figure down by leveraging advanced practice providers (APP) such as Emergency Medicine PA or Emergency Nurse Practitioners (ENP) through Hospital Procedures Courses.
Who Is Considered An Advanced Practice Provider (APP)
Advanced practice provider is a general term used for members of interdisciplinary teams, such as physician assistants (PAs) and nurse practitioners (NPs).
With an estimated 56.8 million people worldwide needing emergency care each year, the demand for APPs has grown exponentially. They meet the needs of emergency medicine providers by delivering critical care and emergency medicine to patients in the ICU and ED.
These healthcare practitioners ease the burden on ER physicians. In 2020 alone, they saw 131 million visits.
Role Advanced Practice Providers Play in Hospital Procedures
As highly trained healthcare professionals, emergency NP and PA emergency medicine provide patients with medical attention at various levels of acuity.
They help with the following:
- Counsel and instruct patients on mental and physical health
- Obtain consultations
- Order medicine and other treatments
- Order and perform procedures (diagnostic and therapeutic)
- Perform or assist with patient screening and laboratory procedures
- Perform procedures like wound care, abscess incision and drainage, blood gas sampling, central line placement, foreign body removal, lumbar puncture, arterial line placement, endotracheal intubation, thoracentesis and paracentesis.
- Record patient history and other relevant information on a patient’s chart
- Refer patients to appropriate specialists
And their expertise goes beyond procedure skills. A 2020 study indicated that PAs and RNs safely and seamlessly perform routine procedures like arterial line placement or central venous catheters and tracheal intubation in critically ill patients.
Per a 2012 study, 23% of nurse practitioners stay on top of this in acute care; while PAs are said to be able to perform 80% of the functions associated with physicians.
This means hospital administrations can build on the training AAPs received in their respective graduate programs. By giving them access to further education to achieve competency and bring more value to emergency medicine and critical care settings, they can significantly improve patient care.
Education and Training for APPs: All You Need to Know
Physician Assistants
In addition to learning fundamentals of hospital procedures during their graduate and master’s programs, physician assistants also take anatomy courses. They are trained in technical skills and procedures, according to the Accreditation Review Commission on Education for the Physician Assistant, Inc (ARC-PA).
Emergency Medicine PA must also comply with licensure requirements in the state they practice in and obtain the NCCPA EM Certificate of Added Qualifications.
To qualify for emergency medicine, they must document 3,000 hours of experience in emergency medicine and complete ACLS, PALS, ATLS, and an airway course, among other prerequisites, to be considered for procedural expertise in ED.
Nurse Practitioners
Advanced practice nurse practitioners (APNPs) with a Master of Nursing (MSN) or Doctor of Nursing Practice Degree (DNP) can specialize in one of six educational programs available. They can enhance their skills and career opportunities by qualifying for caring for patients with rapidly deteriorating medical conditions.
Per the National Organization of Nurse Practitioner Faculties (NONPF), they must learn skills like suturing, wound debridement and other emergency procedures or hospital procedures to develop the required procedural training.
In both cases, training for medical procedures is typically done in a simulation setting. This is because opportunities to study during clinical rotations are influenced by many factors, such as the location and the skillset of the preceptor.
Only 30% of these procedures can be performed in simulated centers, so any knowledge APPs gain in the remaining 70% will be purely formative and will be evaluated as such.
Why You Should Integrate APPs Into Your Team
In 2006, more than 12% of ED cases were cared for by NPs or PAs, and it’s easy to see why. When APPs are trained in emergency medicine and their skills are incorporated into acute care provider roles, you do more than ensure successful care delivery.
You also relieve the burden caused by the growing number of patients on emergency room physicians’ duties, improve outcomes, reduce hospital length of stay, and minimize waiting times. This can help increase turnover without compromising patient care and taking on additional staff.
Emergency NP and PA emergency medicine can be trained to perform:
- Laceration repair
- Cast and splint application
- Procedural sedation
- Regional block anesthesia
- Arthrocentesis
- Lumbar puncture
- Thoracentesis
- Urethral catheterization
- Paracentesis
- Central line placement
- Intubation
If you want to tap into the power of this workforce, it’s best to provide them with real-world practice and supervision from a qualifying physician.
An example of this is the PAIN (Practical Anatomy Instruction for Nurse Practitioners and Physician Assistants in Critical Care) course. It equips APPs with additional procedural skills that will expand their responsibilities in the emergency department.
APPs can also develop their procedural and diagnostic testing skills by taking specialty courses like Fundamentals of Critical Care Support (FCCS). These teach the basic concepts of managing critically-ill patients for improved outcomes.
In Conclusion
Adding emergency medicine PAs and Emergency NP (ENP) professionals in ED and ICU can ease the burden of the physician shortage and help strengthen the healthcare workforce. This is especially crucial in underserved communities.
These qualified, highly trained professionals through Hospital Procedures Courses are crucial for time and information management and speedy delivery of services for time-sensitive conditions and critically ill patients.
Resources:
Mowery, N. Dougherty, S. Hildreth, A. Holmes, J. Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients. J Trauma 70(6): 1317-25
Kleinpell, R. Goosby, M. American Academy of Nurse Practitioners National Nurse Practitioner sample survey: focus on acute care. Nurse Pract. 24(12):690-4
Wu, F. Darracq. M. Physician assistant and nurse practitioner utilization in U.S. emergency departments, 2010 to 2017. Emerg Med. 2020;38(10):2060-2064
Jones, S. Moulton, C. Swift, S. Molyneux, P. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Observational Study. 2022. 39(3):168-173
Davis, D. Warrington. S. Simulation Training and Skill Assessment in Emergency Medicine.
Gottenborg, E. Limes, J. Olson, A. Wolfe, B. Learning Together: Integration of Advanced Practice Providers into a General Medicine Ward Team. Gen Intern Med. 2019 34(5)
Kreeftenberg, H. Aarts, J. Bindels, A. Procedures Performed by Advanced Practice Providers Compared With Medical Residents in the ICU: A Prospective Observational Study. Crit Care Explor 2020 2(4)