PROGRESS REPORT
To: Dr. Erika Paterson, UBC Department of English
From: Owen Picton
Date: 23 June 2017
Subject: Progress Report on Feasibility of Adding Physician Extenders to the St. Paul`s Hospital Emergency Department (SPHED) Fast Track Staff
Project Overview
For my formal report, I am investigating the feasibility of physician extenders (non-physician experts) to the St. Paul’s Hospital Emergency Department Fast Track staff in order to provide consistent, effective, and maximally efficient care to more patients who are assigned to the Fast Track area of the Emergency Department.
Tasks Completed
- Reviewed the scope of practice of many health care professionals (HCPs) and chose the HCPs who would be most appropriate to support the staff members currently working in the SPHED.
- Completed introductory literature search for instances where physician extenders are used in medical practices.
- Arranged interview with the St Paul’s Hospital Emergency Department Operations Leader.
- Developed questions for the staff survey and the patient survey.
- Sketched out the typical Fast Track patient care trajectory.
- Investigated the method of obtaining information from the BC Ministry of Health.
Tasks In Progress
- Investigating what general information about the SPHED requires clearance under the Freedom of Information and Protection of Privacy Act (FOIPPA) and which can be obtained without such clearance.
- Ensuring survey questions pass UBC ethical clearance.
Tasks to be Completed
- Administer survey to St. Paul’s Hospital staff and patients.
- Collate information gathered from surveys and examine trends in the data.
- Obtain FOIPPA-governed data and analyze it.
- Interview the St. Paul’s Hospital Emergency Department Operations Leader, the St Paul’s Hospital Physician Leader, and
- Analyze cost of hiring, training, and retaining physician extenders vs. nurses and physicians.
Completion Date: The first draft of this document is due to be completed on 10 July 2017.
The report is currently behind schedule. However, once the FIPPA-protected information is obtained, the time should be able to be made up with no changes to the completion date needed.
Complications
- Obtaining data about patients and data from patients in a public hospital setting is an intricate, time-consuming process. St. Paul’s Hospital has a very strict policy regarding patient involvement in surveys due to privacy concerns.
- The staff is undergoing “investigation fatigue”—fatigue from the sheer increase in the amount of work each has to complete as well as the sheer number of different investigations into streamlining care and the number of trial initiatives that have been implemented and abandoned. Although they welcome any assistance in doing their jobs that they can get, they have been Six-Sigma’ed and LEANed to death already.
- The issues of scopes of practice and job descriptions are very apparent and prevalent. While some staff members welcome the idea of additional help, they also see the addition of non-nursing or non-medical staff to the department roster as a threat to their employment. They are very aware that changes to their job descriptions have the possibility of negatively affecting their ability to take on overtime shifts or even maintain their lines. They are willing to help in theory, but their willingness to potentially handicap their own efforts to get ahead puts the value of their help in question.