PhD Project - Non-physician clinicians in the Emergency Department: an exploration of the impact of information communication technology in facilitating role change in the delivery of care

PhD student: Julie (Yu Jia) Li

Supervisor: Professor Johanna Westbrook

Co-supervisors: Dr Andrew Georgiou, Dr Joanne Callen

Background:

Evolving in the 1960s in the United States, the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) (collectively known as non-physician clinicians) were introduced to alleviate maldistribution of primary care physicians and the rising cost of healthcare. The concept of the non-physician clinician is relatively new to Australia. In the advent of the state-wide implementation of a compulsory clinical patient information system, research is yet to be undertaken on the influence of such Information Technology on changing and defining the clinical roles and work practices of such non-physician clinicians.

Aim of Research:

To explore the influence of a computerised clinical information system on shaping clinical and patient management roles of PAs and NPs in the ED in the advent of the mandatory state-wide implementation of an integrated patient information system.

Research Questions:

• What is the current role of non-physician clinicians in a highly computerised ED?
• What is the impact of non-physician clinicians on ED outcomes?
• How do the roles of non-physician clinicians affect staff functioning and departmental dynamics of the ED?
• What is the extent to which IT is responsible for shaping the role and work of non-physician clinicians?
• What are the implications of non-physician clinician roles for the quality of patient care?

Description of Research:

A formative, multi-method 3-year longitudinal study will be conducted in the Emergency Departments of two large metropolitan public teaching. The project will employ both interpretive and interactionist research methods and involve 3 areas.

Study 1 will determine the current roles and work practices of non-physician clinicians. Systematic observations of non-physician clinician work processes will be supplemented with in-depth interviews with all non-physician clinicians and a sampling of nurses and physicians to triangulate data collected on the perceived role and contribution of non-physician clinicians to the ED, and to convey how said roles integrate into the interrelated mesh of clinical roles within the ED.

Study 2 will measure the impact of non-physician clinician roles on ED outcomes by developing and testing a suite of key performance indicators identified from study 1 to provide a summative evaluation of both the direct and indirect impact of non-physician clinicians on ED outcomes. Observational data collected in study 1 will be used in conjunction with data gathered from in-depth interviews with all non-physician clinicians in study 3 to investigate the role of the mandatory use of a clinical patient information system on shaping the work of non-physician clinicians in the ED.

Significance:

Little is known about the clinical role and financial impact of the recently introduced PAs within real healthcare settings whilst the role of the NP, especially those in the Emergency Department, remains ill-defined in spite of their potential to transform the healthcare environment. This study will investigate the current roles of PAs at all pilot sites in NSW and broaden the understanding of NP roles in the context of a highly computerised emergency department in Australia. Study results will contribute to a more holistic insight into the potential impacts of clinical IT implementation on clinical work culture. In addition, it will identify the underlying mechanisms which determine optimal systems functioning within clinical departments and advise future implementation of information technology in the shift towards full computerisation of the healthcare system.