Doan Quynh, Piteau Shalea, Sheps Sam, Singer Joel, Wong Hubert, Johnson David, Kissoon Niranjan
CJEM. 2013 Nov;15(6):321-9. doi: 10.2310/8000.2013.131030.
To define the range of clinical conditions Canadian emergency pediatricians consider appropriate for management by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).
We conducted a cross-sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N = 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions.
Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had ≥ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7-89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5-91.5% v. 82.2-84.7%).
This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician.
明确加拿大急诊儿科医生认为适合由医师助理（PA）管理的临床情况范围，以及PA在儿科急诊科（PED）应拥有的自主程度。
我们使用电子问卷技术（Active Campaign Survey工具）开展了一项全加拿大范围的横断面调查。我们通过加拿大儿科急诊研究（PERC）网络数据库（N = 297）确定PED医生为调查对象。评估了三项结果指标：人口统计学信息、对PA的熟悉程度以及PA在PED中的临床角色。针对57种常见非急诊临床情况评估了PA的参与程度。
297名医生中，152名完成了调查，回复率为51.2%。在57种临床类别中，没有一种在无需医生直接参与的情况下，关于PA管理达成至少85%的共识。24种临床情况中，≥15%的受访者一致认为PA的任何参与都不合适。对于其余33种临床情况，超过85%的受访者认为PA可以适当管理，但在需要医生直接监督还是仅间接监督方面存在分歧。受访者认为适合PA参与的情况数量选择因他们工作的急诊科规模（大型急诊科为87.7 - 89.1%，小型急诊科为74.2%）以及对PED中PA临床工作的熟悉程度（90.5 - 91.5%，82.2 - 84.7%）而异。
这项对加拿大PED医生的全国性调查表明，他们认为PA可以帮助处理大量前往PED的非急诊临床病例，但这些临床诊疗必须由医生直接监督。
