title: Physician assistants in emergency medicine: the impact of their role.
abstract: BACKGROUND
  Emergency medicine (EM) in North America has been undergoing significant transformation since the new century. Recent health care reform has put it center stage. Access demand for acute care is increasing at the same time the number of qualified emergency physicians entering service has reached a plateau. Physician assistants (PAs), one alternative, are employed in emergency departments (EDs), but little is known about the impact of their role.
  
  
  OBJECTIVE
  This was a literature review to identify the current role of PAs in patient treatment and the management of emergency services.
  
  
  METHODS
  All publications and designs from 1970 through 2009 were identified using multiple science citation indices. Each author reviewed the literature, and categories were developed based on consensus.
  
  
  RESULTS
  Thirty-five articles and reports were sorted into categories of interest: prevalence of PAs in EDs, efficiency and quality of care, patient satisfaction, rural emergency care, and legal issues. Each category is summarized and discussed. Evidence comparing the clinical effectiveness of PAs to mainstream management of emergency care was only fair in methodologic quality.
  
  
  CONCLUSIONS
  The use of PAs in EDs is increasing, and this expansion is due to necessity in staffing and economy of scale. Unique uses of PAs include wound management, acute care transfer management to the wards, and rural health emergency staffing. While their role seems to be expanding, this assessment identified gaps in deployment research using appropriate outcome measures in the area of clinical effectiveness of PAs.
authors.affiliation: Department of Veterans Affairs, University of Texas Southwestern Medical Center, Dallas, TX, USA. rodhooker@msn.com
authors.forename: Roderick S
authors.initials: RS
authors.lastname: Hooker
authors.forename: David J
authors.initials: DJ
authors.lastname: Klocko
authors.forename: G Luke
authors.initials: GL
authors.lastname: Larkin
mesh_terms: D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010823:Physician Assistants; D024382:Professional Role