Introducing physician assistants into an intensive care unit: process, problems, impact and recommendations.

The National Health Service (NHS) is facing substantial staffing challenges arising from reduced working hours, fewer trainees and more protected training of those trainees. Although increasing consultant-delivered care helps to meet these challenges, there remains a need to remodel the workforce. One component of the solution is physician assistants (PAs), who are professionals trained in patient assessment and care, working under the supervision of trained doctors. In October 2010, three PAs began working in the paediatric intensive care unit (PICU) at St George's Hospital, Tooting, which is a large tertiary hospital. This study used surveys and semi-structured interviews to explore the process and end results of this development. Initially, there was a large discrepancy between expectations and the capabilities of the PAs. Shortly after starting, there was friction arising from PAs being untrained in PICU activities, and the facts that they would take training opportunities from other staff and that their remuneration was disproportionate to their usefulness. At five months, all those interviewed stressed the positive impact of PAs on patient care and the running of the unit. Staff had found that the PAs had integrated well and there was little evidence of earlier frictions. When surveyed at 10 months, PAs were undertaking most PICU procedures, albeit with some supervision. The study shows that PAs can be a valuable addition to the medical workforce, but that predictable problems can mar their introduction. Solutions are suggested for other units intending to follow this model.