Jane R. Perlman Fellow, Division of Emergency Medicine, NorthShore University HealthSystem, Evanston, IL, United States.
Pulmonary and Critical Care, NorthShore University HealthSystem, Intensive Care Unit, Highland Park, IL, University of Illinois, College of Nursing, Chicago, IL, United States.
Dis Mon. 2021 Jan;67(1):101013. doi: 10.1016/j.disamonth.2020.101013. Epub 2020 Jul 11.
Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. This article aims to collect information on how these roles compare as well as which procedures are actually being performed by advanced practice providers in the emergency department and critical care settings. Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.
高级执业医师（医生助理和执业护士）是跨学科团队的一部分，对于重症监护病房和急诊科中急性重症患者的成功治疗和改善预后至关重要。由于医生短缺和病情经常迅速恶化的患者复杂性增加，增加高级执业医师并扩大急性护理提供者的角色，可带来积极的结果，包括缩短住院时间、改善护理连续性、降低医院成本以及提高住院患者、医生和护士的工作满意度。本文试图探讨高级执业医师（APP）在急性护理环境中执行诊断和治疗程序、医生助理（PA）和执业护士（NP）项目中提供的教育以及为实现程序执行的能力和舒适度所需的研究生培训方面所扮演的角色。PA 和 NP 的培训和认证通常在州一级和实践地点有所不同。本文旨在收集有关这些角色如何比较以及哪些程序实际上是由急诊和重症监护环境中的高级执业医师执行的信息。考虑到医疗保健系统向基于团队的护理模式转变，APP 执行的程序符合所服务的患者群体的需求，并与医生提供者在团队中执行的程序相对应。根据国家提供者标识符独立计费具有成本效益，但可能受到当前医生报销系统的影响或医疗系统对 APP 计费流程的理解不足。尽管在这一领域的研究有限，但本文旨在探讨当前在急诊科和重症监护环境中执行程序的 APP 的使用情况和实用性。
