TABLE 1 : Demographic information of West Virginia trauma centers participating in the survey |
|
Level I |
Level II |
Level III |
Level IV |
Total |
Trauma Center |
2 |
1 |
1 |
13 |
17 |
% of total Trauma Centers |
12 % |
6 % |
6 % |
76 % |
|
Total PAs |
3 |
6 |
0 |
39 |
48 |
Total NPs |
9 |
0 |
1 |
23 |
33 |
Advanced Practice Providers ( APPs ); Physicians ’ Assistants ( PAs ); Nurse Practicioners ( NPs ) |
TABLE 2 : Overview of the roles of PAs and NPs in WV trauma centers |
|
Trauma Bay |
OR |
ICU |
Step-down |
Floor |
PAs ( n = 48 ) |
88 % |
44 % |
63 % |
60 % |
54 % |
NPs ( n = 33 ) |
79 % |
0 % |
61 % |
55 % |
48 % |
Physicians ’ Assistant ( PAs ); Nurse Practicioners ( NPs ); Operating room ( OR ); Intensive Care Unit ( ICU ) |
Trauma centers that provided responses to the initial survey received a follow-up email survey that focused on educational opportunities provided to the APPs . These questions queried information regarding participation in trauma training courses , including Advanced Trauma Life Support ( ATLS ), Fundamentals of Critical Care Support ( FCCS ), Rural Trauma Development Course ( RTTDC ), Stop the Bleed ( STB ) and disaster preparedness courses . Additional information was obtained regarding the desire for opportunities for advanced procedure-based training , including central and arterial line placement and chest tube management . Data are presented as descriptive statistics only and include raw numbers and percentages .
RESULTS
Completed surveys were returned by 81 % ( 17 / 21 ) of the WV trauma centers that received the survey . Trauma center designation is reported in Table 1 . The majority of trauma centers in the state are designated as Level IV ( 76 %). Fifteen trauma centers ( 15 / 17 ; 88 %) reported having APPs involved in providing care for injured patients . The total number of APPs participating in trauma care at WV accredited trauma centers were 81 : 48 PAs and 33 NPs . Additional breakdown of trauma center by level of designation and number of APPS involved in trauma care is listed in Table 1 .
Both PAs ’ and NPs ’ roles of providing care to trauma patients were found to overlap between the trauma bay , OR , ICU , stepdown unit , and floor ( Table 2 ). PAs most frequently reported participating in trauma patient care in the trauma bay ( 88 %) but were well represented in all locations , including the OR ( 44 %), ICU ( 63 %), and step-down unit ( 60 ). NPs reported providing care mostly in the trauma bay ( 79 %) and ICU ( 61 %). In addition , 14 ( 82 %) of the trauma centers responding to the survey indicated that their APPs participate in bedside procedures , including placing chest tubes , central lines , and arterial lines .
Only six trauma centers ( 35 %) provided responses to the follow-up survey . All six indicated their APPs had completed the ATLS course . None of the centers provided FCCS for their APPs , but all responded they were interested in bringing this course to their institution . APPs had participated in other trauma related courses such as RTTDC , STB , and disaster preparedness courses . Additionally , trauma directors and program managers at trauma centers that had not previously provided these courses expressed interest in providing these educational opportunities for their APPs ( Table 3 ). None of the trauma centers offered specific training courses in bedside procedures , but all were interested in providing additional skills training . Please refer to Table 3 .
DISCUSSION
Our results provide evidence that rural states such as WV rely on APPs to participate in trauma care throughout all levels of the state trauma system . Nearly all ( 88 %) of the trauma centers included in this preliminary survey reported that APPs were integral to and participated in the care of injured patients at their hospitals . An earlier study by Nyberg , which surveyed 246 major trauma centers across the US , demonstrated that less than 35 % employed APPs on their trauma services . 10 Over time , the role of APPs or physician extenders on traditional surgical services has expanded . 11 Our results suggest that APPs in WV are not only present on trauma services but also have active roles in many locations in the hospital where injured patients receive care , even transitioning between areas , such as the trauma bay and ICU . In addition , 93 % of the state ’ s trauma centers employ APPs who are involved in performing invasive bedside procedures such as chest tubes , central lines , and arterial lines . In comparison , Nyberg reported that only one-third of APPs at trauma centers participated in the same invasive bedside procedures . 10
Several studies have specifically evaluated patient outcomes , such as hospital mortality and complications , after the implementation of APPs on trauma services . Gillard reported no difference in the hospital mor
West Virginia Medical Journal • December 2021 • 29