Role of NPs/PAs in surgery?

[sozme]

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I've seen a lot of services where NPs are rounding on patients as part of the neurosurgery or trauma or vascular surgery team. Just curious what their role typically is since they don't actually do the procedures (or do they?)

 

[Psai]

I've seen a lot of services where NPs are rounding on patients as part of the neurosurgery or trauma or vascular surgery team. Just curious what their role typically is since they don't actually do the procedures (or do they?)

Write notes after getting the plan from the senior residents or attendings. Put in orders. Keep an eye on patients while the surgeons are in the operating room and brings things to their attention.

 

[Pir8DeacDoc]

They can be very valuable. Helpful with arranging discharges(i.e. set up home health, home PT/OT, home IV antibiotics) or just a plain old discharge summary. Also, because they do the same thing day by day and the residents rotate here and there they know each attending preference usually better than the residents (or at least for sure better than the interns). I've seen them used in vein harvests for CABG but otherwise not really seen them in the OR's.

 

[WinslowPringle]

They are wonderful with discharge summaries. Absolutely wonderful.

On the non-teaching services here, they tend to write the progress notes after the attending has rounded. There is a surgical PA who is a first assist in a surgical sub-specialty.

 

[thedrjojo]

I've seen a lot of services where NPs are rounding on patients as part of the neurosurgery or trauma or vascular surgery team. Just curious what their role typically is since they don't actually do the procedures (or do they?)

They function as about at the level of the PGY2-3 on the team that has been there for a LONG time and knows the preferences of the attendings. When I was the PGY1-2 I used to be annoyed by them because they don't necessarily work with the same speed and urgency of the junior resident, however, as the PGY3-4 I've learned how invaluable they are as I'm more or less running the service and know they are a reliable source to deal with the nursing staff/attendings/keep an eye on the functionality of the service if the juniors aren't up to snuff or operating.

 

[Winged Scapula]

We have one (PA) in the office.

She assists my partner in the OR and closes the incisions while my partner is starting in another room.

She does the pre- and post-op orders; discharge summaries.

In the office, she sees the benign post-ops; calls patients with pathology and imaging results, calls in scripts or see patients with post op problems, freeing us up for the more complex patients and the new cancers. We will likely also transition her to seeing routine followups and benign S&S stuff that we get sent.

With changes in insurance reimbursement affecting RNs, I'll be interested in seeing whether or not people transition to PAs.

 

[Psai]

We have one (PA) in the office.

She assists my partner in the OR and closes the incisions while my partner is starting in another room.

She does the pre- and post-op orders; discharge summaries.

In the office, she sees the benign post-ops; calls patients with pathology and imaging results, calls in scripts or see patients with post op problems, freeing us up for the more complex patients and the new cancers. We will likely also transition her to seeing routine followups and benign S&S stuff that we get sent.

With changes in insurance reimbursement affecting RNs, I'll be interested in seeing whether or not people transition to PAs.

What changes affect RNs?

 

[Winged Scapula]

What changes affect RNs?

CMS not paying for them to first assist,

 

[Frazier]

NP's did a lot of the floor work, PA's did some floor work and assisting in OR.

I was thoroughly suprised how involved a particular PA was during thoracic surgeries.

That said, he was a very good PA.

 

[Psai]

NP's did a lot of the floor work, PA's did some floor work and assisting in OR.

I was thoroughly suprised how involved a particular PA was during thoracic surgeries.

That said, he was a very good PA.

I've seen surgeons who do the same cases over and over again the exact same way and the PA does the exact same thing over and over again. They do things like vein harvesting so that the surgeon can crank out more cases.

 

[SouthSideSteve]

I've seen surgeons who do the same cases over and over again the exact same way and the PA does the exact same thing over and over again. They do things like vein harvesting so that the surgeon can crank out more cases.

PAs harvesting conduit isn't really for efficiency sake (obviously concurrent harvests of LIMA & saphenous speed things up), but more so necessity. Open harvest of the saphenous is rarely done and most CV fellows have no clue how to do it endoscopically. A PA is almost a necessity in a CV practice.

The biggest boost to efficiency is when an attending can come off pump and leave a PA to decannulate, dry up, & close. Drying up is the crappiest part of any cardiac case.