Johal Jagdeep, Dodd Andrew
From the Department of Orthopedic Surgery, University of Calgary, Calgary, Alta.
Can J Surg. 2017 Jun;60(3):172-178. doi: 10.1503/cjs.001516.
With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload.
We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles.
Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs.
The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.
随着住院医师值班时长限制的引入以及由此导致的医院内部实习医生短缺，需要一种长期解决方案来确保安全、高效的患者护理。一种解决方案是在各种医疗环境中整合执业护士（NP）和医师助理（PA）。我们试图研究NP和PA在外科/创伤服务中的使用情况及其对患者结局和住院医师工作量的影响。
我们对EMBASE、Medline、CINAHL和Cochrane对照试验中央注册库进行了系统评价。我们纳入了（所有设计类型的）研究，这些研究考察了NP和PA在成人外科和创伤服务中的使用情况，并报告了以下结局：并发症、住院时长、再入院率、患者满意度和感知的护理质量、住院医师工作量、住院医师工作时长、住院医师睡眠时间、住院医师满意度、住院医师感知的护理质量、其他医护人员满意度和感知的护理质量以及经济影响评估。我们排除了评估非外科/创伤服务或儿科的研究以及综述文章。
29篇文章符合纳入标准。增加NP和PA后，患者住院时长缩短，发病率和死亡率未变。此外，住院医师工作量减少，睡眠时间增加，手术时间得到改善。患者和医护人员满意度较高。几项研究报告称增加NP/PA后节省了成本。
在外科/创伤服务中增加NP和PA似乎是一种安全、经济有效的方法，可应对因住院医师值班时长限制而产生的一些挑战。需要更多高质量研究来证实这些发现，并进一步评估在手术团队中增加NP和PA的经济影响。
