title: Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program.
abstract: BACKGROUND
  Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care.
  
  
  METHODS
  A mixed-methods evaluation was conducted using semi-structured interviews (n= 38), health care provider (n= 28) and patient surveys (n= 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post).
  
  
  RESULTS
  Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected.
  
  
  CONCLUSIONS
  After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.
authors.affiliation: From Workforce Research & Evaluation, Alberta Health Services, Calgary, Alta., (Hepp, Suter); Provincial Medical Affairs, Alberta Health Services, Calgary, Alta., (Nagy, Knorren); and the Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Alta. (Bergman).
authors.forename: Shelanne L
authors.initials: SL
authors.lastname: Hepp
authors.affiliation: From Workforce Research & Evaluation, Alberta Health Services, Calgary, Alta., (Hepp, Suter); Provincial Medical Affairs, Alberta Health Services, Calgary, Alta., (Nagy, Knorren); and the Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Alta. (Bergman).
authors.forename: Esther
authors.initials: E
authors.lastname: Suter
authors.affiliation: From Workforce Research & Evaluation, Alberta Health Services, Calgary, Alta., (Hepp, Suter); Provincial Medical Affairs, Alberta Health Services, Calgary, Alta., (Nagy, Knorren); and the Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Alta. (Bergman).
authors.forename: Dwayne
authors.initials: D
authors.lastname: Nagy
authors.affiliation: From Workforce Research & Evaluation, Alberta Health Services, Calgary, Alta., (Hepp, Suter); Provincial Medical Affairs, Alberta Health Services, Calgary, Alta., (Nagy, Knorren); and the Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Alta. (Bergman).
authors.forename: Tanya
authors.initials: T
authors.lastname: Knorren
authors.affiliation: From Workforce Research & Evaluation, Alberta Health Services, Calgary, Alta., (Hepp, Suter); Provincial Medical Affairs, Alberta Health Services, Calgary, Alta., (Nagy, Knorren); and the Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Alta. (Bergman).
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Bergman
mesh_terms: D000359:Aftercare / Q000379:methods* / Q000592:standards; D000416:Alberta; D006801:Humans; D019982:Organizational Case Studies; D019637:Orthopedic Procedures / Q000379:methods* / Q000592:standards; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D010823:Physician Assistants / Q000458:organization & administration* / Q000592:standards; D024382:Professional Role; D034941:Upper Extremity / Q000601:surgery