Phillips Andrew W, Klauer Kevin M, Kessler Chad S
Andrew W. Phillips is a clinical assistant professor in the Department of Emergency Medicine at the University of North Carolina at Chapel Hill. Kevin M. Klauer is chief medical officer of hospital-based services, emergency medicine chief risk officer, and executive director of patient safety organization for TeamHealth, and an assistant clinical professor at Michigan State University's College of Osteopathic Medicine. Chad S. Kessler is deputy chief of staff of the Durham (N.C.) VA Healthcare System. The authors have disclosed no potential conflicts of interest, financial or otherwise.
JAAPA. 2018 May;31(5):38-43. doi: 10.1097/01.JAA.0000532118.98379.f1.
The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described.
We conducted two cross-sectional electronic surveys of the American College of Emergency Physicians' council. Survey construction was informed by interviews and evaluated with validity and reliability studies. Univariate analyses to establish associations also were performed.
Most councilors' departments employ PAs and NPs (72.4% of 163 responses). Supervisory requirements varied greatly among respondents for the same emergency severity index (ESI) level. Regardless of experience level, NPs were reported to use significantly more resources than PAs; chi-square(4) = 105.292, P < .001 for less-experienced PAs or NPs; chi-square(4) = 120.415, P < .001 for more experienced PAs or NPs.
Councilors reported great variation in PA and NP scope of practice. The results also suggest that new graduate PAs may be more clinically prepared to practice in the ED than new graduate NPs.
近年来，急诊科医师助理（PA）和执业护士（NP）人数前所未有的激增发展迅速，但实践范围和实践模式尚未得到充分描述。
我们对美国急诊医师学会理事会进行了两次横断面电子调查。调查构建参考了访谈结果，并通过效度和信度研究进行评估。还进行了单变量分析以建立关联。
大多数理事会成员所在部门聘用了医师助理和执业护士（163份回复中的72.4%）。对于相同的急诊严重程度指数（ESI）水平，受访者的监督要求差异很大。无论经验水平如何，据报告执业护士使用的资源比医师助理多得多；经验较少的医师助理或执业护士，卡方值(4)=105.292，P<.001；经验较丰富的医师助理或执业护士，卡方值(4)=120.415，P<.001。
理事会成员报告称医师助理和执业护士的实践范围差异很大。结果还表明，新毕业的医师助理可能比新毕业的执业护士在急诊科临床实践方面准备更充分。
