Marijke J C Timmermans1,2, Anneke J A H van Vught2, Michiel Van den Berg3, Erik D Ponfoort4, Frank Riemens5, Jacco van Unen6, Theo Wobbes7, Michel Wensing1, Miranda G H Laurant1,2. 1. Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands. 2. Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands. 3. Department of Surgery, Scheper Hospital, Emmen, The Netherlands. 4. Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands. 5. Department of Surgery, Van Weel Bethesda Hospital, Dirksland, The Netherlands. 6. Department of Surgery, Laurentius Hospital, Roermond, The Netherlands. 7. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
RATIONALE, AIMS AND OBJECTIVES: Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. METHODS: In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. RESULTS: We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). CONCLUSION: Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
RATIONALE, AIMS AND OBJECTIVES: Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. METHODS: In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. RESULTS: We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). CONCLUSION: Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
Authors: Marijke J C Timmermans; Geert T van den Brink; Anneke J A H van Vught; Eddy Adang; Charles L H van Berlo; Kim van Boxtel; Weibel W Braunius; Loes Janssen; Alyssa Venema; Frits J van den Wildenberg; Michel Wensing; Miranda G H Laurant Journal: BMJ Open Date: 2017-07-10 Impact factor: 2.692
Authors: Marijke J C Timmermans; Anneke J A H van Vught; Yvonne A S Peters; Geert Meermans; Joseph G M Peute; Cornelis T Postma; P Casper Smit; Emiel Verdaasdonk; Tammo S de Vries Reilingh; Michel Wensing; Miranda G H Laurant Journal: PLoS One Date: 2017-08-09 Impact factor: 3.240
Authors: Jacqueline M Bos; Marijke J C Timmermans; Gerard A Kalkman; Patricia M L A van den Bemt; Peter A G M De Smet; Michel Wensing; Cornelis Kramers; Miranda G H Laurant Journal: PLoS One Date: 2018-08-23 Impact factor: 3.240