SCIENTIFIC
The Role of Advanced Practice Providers in the West Virginia Trauma System
AUTHORS :
Afton Wagner , CCRP Department of Surgery , West Virginia University
Jordan Brewer , MPAS , PA-C Department of Surgery , West Virginia University
Daniel Grabo , MD , FACS Department of Surgery , West Virginia University
INTRODUCTION
Trauma and accidental injuries are a leading cause of death in the United States ( US ). 1 Roughly 20 % of the US population lives in rural areas , but these patients account for approximately 60 % of trauma deaths nationally . 2 , 3 Rural trauma patients have increased mortality rates from traumatic injuries compared to the urban population and are 14 % more likely to die from traumatic injuries than non-rural residents . 4 Furthermore , approximately 50 % of motor vehicle crash deaths occur in rural settings . 5
There are many challenges to the delivery of trauma care in rural environments , including medical transportation difficulties , increased distance and travel time to trauma centers , and limited hospital resources such as physician staffing . 2 , 3 Challenges in transportation such as inclement weather and difficult terrain often lead to increased prehospital time . Rural trauma patients are more likely to die in the prehospital setting as compared to urban trauma patients . 6 Only 24 % of the rural population has access to a Level I or II trauma center within an hour from their homes , 2 presenting a dangerous challenge as timely transfer to a Level I or II trauma center has been shown to decrease risk of mortality within the first 30 days . 7
While it is clear there is a need to provide trauma care in rural settings , there is an overall lack of physicians in rural areas , as well as potential variations in the quality of
ABSTRACT
BACKGROUND Injured patients in rural states like West Virginia ( WV ) rely on advanced practice providers ( APPs ) to provide initial care in Level III and IV trauma centers prior to transfer to medical centers with additional resources . This is a first attempt to survey trauma centers in WV and report on the roles that APPs perform in trauma care .
METHODS Trauma directors and program managers at all 21 accredited trauma centers in WV were queried via an online survey . The number of APPs — physicians ’ assistants ( PAs ) and nurse practitioners ( NPs )— participating in trauma care were queried from each center . Information was obtained on the location where APPs participated in trauma care , such as : trauma bay , operating room , and intensive care unit . Follow-up surveys inquired about trauma educational opportunities provided
trauma care provided at rural hospitals . 3 , 8 One potential solution to the lack of physician staffing in rural hospitals is the employment of advanced practice providers ( APPs ), such as nurse practitioners ( NPs ) and physicians ’ assistants ( PAs ). The PA profession was originally created in the 1960s as a response to a physician shortage , especially in rural areas , to expand healthcare and continues to provide a solution to this problem today 8 . APPs provide key roles in providing trauma care in rural states such as West Virginia ( WV ).
This study was undertaken to better understand the role of APPs in trauma centers throughout the state . The primary aim seeks to identify the roles in which APPs are employed to provide care to trauma patients and where they deliver this care from patient arrival through final disposition in WV trauma centers . The secondary aim seeks to better understand the educational opportunities offered to APPs by the state ’ s trauma centers . to APPs , including : Advanced Trauma Life Support ( ATLS ), Rural Trauma Team Development Course ( RTTDC ), and Stop the Bleed ( STB ).
RESULTS Responses were received from 81 % of WV ’ s trauma centers . The total number of APPs participating in trauma care were 81 ( PAs = 48 ; NPs = 33 ). The majority of APPs performed patient care roles in the trauma bay ( 84 %). The results of the follow-up survey demonstrated that 100 % of trauma centers provide the ATLS course for their APPs , 83 % provide RTTDC , and 50 % provide STB training .
CONCLUSIONS The WV trauma system relies on APPs to deliver care from patient arrival through definitive treatment and disposition . Opportunities exist for education and training of the APP community within a rural trauma system .
METHODS
Following institutional review board approval at the West Virginia University Health Sciences Center , an eight-item , voluntary survey was created using an online research tool . Trauma directors and / or trauma program managers at all 21 accredited Level I to IV trauma centers in WV received the survey .
Facility-specific questions were queried , including name and level of the trauma center as well as the number of APPs involved in trauma care at each facility . Information was requested regarding the physical location in the hospital that APPs participated in trauma care , such as trauma bay , operating room ( OR ), intensive care unit ( ICU ), step-down unit , and floor . Additionally , survey questions inquired about the roles of APPs in bedside procedures , including the insertion and management of chest tubes as well as inserting central and arterial lines .
28 • www . wvsma . org