ED staffing models in teaching hospitals, as a template for UK EM PA utilization?

[dkuhns1]

There is interest in using newly-qualified* British PAs in the EDs there. One of the questions that arises is how best to fit them into staffing patterns, both as novices and then later, when they have gained experience. This is particularly desirable in British teaching hospitals.

 

Does anyone know of any staffing template or other guidance from ACEP (or elsewhere) that might provide some guidance on what might be the best ratio of attending to PA and residents?

 

Or from your own experience of working in an academic center, rough numbers of PAs to resident coverage?

 

 

* only kind that there are as it is so early in the evolution of the British PA model

 

Cheers,

David

[EMEDPA]

I work at 2 major medical ctrs(level 1 and level 2) as well as a rural dept and satelite inner city facility.

at the level 1 we only have 1 resident/shift, 2 md attendings, and 1 pa. the resident and pa do exactly the same things.

at the level 2 we have 4 overlapping pa shifts/day 8a-4a, occasional residents(mostly in fast track-these are fp residents), and 24/7 md coverage.

the rural facility staffs md 24/7 and pa 12p-8p.

the inner city satelite facility is 24/7 pa coverage with a doc on day shift 11a-7p.

[medic25]

We staff two locations; the main hospital ED (level 1 trauma center, academic EM program) and a suburban free-standing ED.

In the main ED, we staff with both PA's and residents (EM and off-service). The ratio is roughly 1 attending: 2-3 PA's per treatment area (13-14 beds, plus all the hallway beds, which can double the number of patients). The fast track area is staffed solely by PA's, with overlapping coverage mid-day.

Resident ratios are roughly similar, if not a little better staffed (they also have a senior resident to help them out).

At the busiest parts of the day, it's in the neighborhood of 5 attendings, 4-6 PA's, 4-5 residents and 2 senior residents.

 

In the free-standing ED we don't have any residents. Only 8 beds, so coverage goes from solo attending 0200-0700 up to attending with 3 overlapping PA's during prime time (usually arriving in staggered shifts at 0800, 1100, and 1400). We try to put the more experienced PA's out here as it's a more autonomous position than in the academic model.