title: Forecasting the effect of physician assistants in a pediatric ED.
abstract: BACKGROUND
  Most pediatric ED visits are for nonemergent problems. Physician assistants are well trained to manage these patients; however, their effect on patient flow in a pediatric ED is unknown.
  
  
  OBJECTIVE
  To compare the effect on key pediatric ED efficiency indicators of extending physician coverage versus adding PAs with equivalent incremental costs.
  
  
  METHODS
  We used discrete event simulation modeling to compare the effect of additional physician coverage versus adding PAs on wait time, length of stay (LOS), and patients leaving without being seen.
  
  
  RESULTS
  Simulation of extended physician coverage reduced wait times, LOS, and rates of leaving without being seen across acuity levels. Adding PAs reduced wait times and LOS for high-acuity visits, and slightly increased the LOS for low-acuity visits.
  
  
  CONCLUSIONS
  With restricted autonomy, PAs mainly benefitted the high-acuity patients. Increasing the level of PA autonomy was critical in broadening the effect of PAs to all acuity levels.
authors: Quynh Doan is an assistant professor in the Department of Pediatrics at the University of British Columbia in Vancouver. William Hall is a research associate at the Centre for Clinical Epidemiology and Evaluation at the University of British Columbia. Steven Shechter is an associate professor in the Sauder School of Business at the University of British Columbia. Niranjan Kissoon is vice president of medical affairs at British Columbia Children's Hospital in Vancouver and a professor of acute and critical care and global child health at the University of British Columbia. In the university's School of Population and Public Health, Sam Sheps and Joel Singer are professors and Hubert Wong is an associate professor. David Johnson is a professor in the Department of Pediatrics and Pharmacology and Physiology at the University of Calgary in Calgary, Alberta. The authors have disclosed that this study received a local seeding grant from the Innovations in Acute Care and Technology cluster of the Child and Family Research Institute. Dr. Doan was also supported with a doctoral award by the Canadian Child Health Clinician Scientist Program while completing this study as part of her dissertation work.
authors: Quynh
authors: Q
authors: Doan
authors: William
authors: W
authors: Hall
authors: Steven
authors: S
authors: Shechter
authors: Niranjan
authors: N
authors: Kissoon
authors: Sam
authors: S
authors: Sheps
authors: Joel
authors: J
authors: Singer
authors: Hubert
authors: H
authors: Wong
authors: David
authors: D
authors: Johnson
mesh_terms: D003198:Computer Simulation; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005544:Forecasting; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D062072:Patient Acuity; D010561:Personnel Staffing and Scheduling; D010823:Physician Assistants / Q000191:economics / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data*