To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.
A strong, positive and collaborative culture exists among the emergency medicine physician assistant (PA), attending physician, nursing staff, the private physicians, hospitalist physicians, consultant physicians, emergency medical services staff, medical and PA students, nurse practitioners, volunteers, and ancillary/ support staff.
- 1. Provides appropriate and timely medical care consistent with the patient's medical condition and within the scope of the PA's professional training, experience and job description. The PA will primarily function in Fast Track but may also be assigned to see patients in the main ED, the chest pain unit or the behavioral health unit as directed by the ED attending. Assesses, evaluates, and informs the physician of changes in the patient's condition during the treatment course.
- 2. Perform comprehensive health assessments of patients to determine the medical, physical, emotional and social needs of patients.
- 3. Order, perform, and interpret laboratory and diagnostic studies. Inform the ED attending of any lab results significantly outside of the normal limits. Insure that all ECGs and chest radiographs, and patient presentation is a CT scan, sonogram, MRI have been ordered are reviewed with the ED attending prior to the patient being discharged.
- 4. Prescribe and order medication in accord with the prudent and current practitioner knowledge of the PA's training and experience.
- 5. Perform diagnostic and therapeutic procedures subject to training and experience and as approved on the list of competencies and privileges. For rarely performed and highly technical skills with a significant risk of complications (e.g., central line placement, lumbar puncture, endotracheal intubation) the attending should be informed before the procedure is performed so that adequate supervision is provided.
- 6. Provide care to non-critical trauma patients including soft tissue injuries and muscular-skeletal injuries. Wound care and fracture management, including the application of splints and suturing are skills performed by the PA. Serious trauma care should be administered in conjunction with the attending physician.
- 7. Instruct and counsel patients about mental and physical health, including diet, disease prevention, and normal development.
- 8. Immediately Inform the ED attending of any unstable or critically ill or injured patient involving adult, pediatric, medical, surgical and gynecologic, obstetrical and trauma related illnesses and injuries.
- 9. Assists the ED attending in the Resuscitation of acutely ill and injured patients.
- 10. Obtain a complete history of the present medical illness, past medical history, review of systems, and medical list and allergies. Perform a vectored physical examination based on the presenting complaint and may include performing a pelvic exam, trauma examination or pediatric assessment. Discussion of the patient's psychosocial issues with a social worker, psychiatrist or case manager.
- 11. Prepares complete, timely and legible medical records that accurately document patient findings.Physical examination, history, allergies, treatment, response to treatment, consultants' reports will be accurately recorded. Seek attending consultation and completion of a faculty note for complicated cases and those described in the appendix. All cases in the main ED, except typical Fast Track type cases will be presented to the physician and have the physician complete the faculty note. PA charting should be completed by the end of his/her shift for discharged patients and by the time the patient is ready to be moved to an in-patient bed for admitted patients.
- 12. Uses standard precautions as outlined in the Department of Infection Control manual. The PA is responsible for informing ED staff regarding any needed special precautions for patients.
- 13. Perform an examination of sexual assault patients while maintaining the chain of evidence.
- 14. Presents a professional image including wearing a white lab coat, hospital ID in a visible location, modest jewelry, and is neat and clean. Identifies self using the phraseology when introducing self: 'I am __ and I am a physician assistant who is working with Dr. __' or something to the same purpose. Ensures that the ED attending is aware of patients who request to be evaluated by a physician.
- 15. Contributes to the productivity and efficient operation of the department. Completes assignments within a reasonable amount of time with minimal or no errors. Exhibits punctuality and flexibility in the work schedule as the ED is staffed 24 hours a day.
- 16. Completes follow-up measures regarding radiology re-reads and any positive lab results including culture results). Seeks attending advice as needed.
- 17. Participates in performance improvement and quality control functions. Maintains accurate follow-up of patient receiving minimal sedation (anxiolysis).
- 18. Contributes to a work place climate that is conducive to open and positive communication and uses positive interpersonal skills with staff, visitors and patients. Follows a teamwork approach which embraces shared goals versus narrower personal focus: is actively cooperative vs. competitive or non-committal. Shares the workload with colleagues without being requested.
- 19. Identifies personal learning needs and opportunity for career growth. Responsible for self learning needs and seeks educational opportunities to meet those needs. Attends in-service programs, monthly ED medical staff meetings, monthly ED PA meetings, and seeks educational opportunities to meet those needs.
- 20. Teaches students which includes: reviewing appropriate physical examination and interviewing skills, discussing approaches to diagnoses, critiquing student write-ups, and evaluating their performance.
- 21. Follow a teamwork approach which embraces shared goals versus narrower personal focus: is actively cooperative vs. competitive or non-committal. Shares the workload with colleagues without being requested.
- 22. Uses the computer patient racking and Meditech EDM system for logging onto a patient; ordering lab tests, medication, other treatments, discharge instructions and medication printing.
- 23. Coordinates patient flow in the ED in order to maximize patient throughput and efficiency. Minimizes the time from patient works-up-in-progress until a decision-to-admit is made. Arranges for patients who need to be admitted, to be expeditiously admitted, including ordering appropriate testing, competing a bed request form, consulting with the private medical doctor.
- 24. Completes incomplete charts within seven (7) days of being informed of incomplete charts.
- 25. Ensures that the chart is co-signed by the assigned ED attending or that a faculty note is written by the attending based on the severity of the patient presentation before it is sent to HIM.
- 26. Is fiscally responsible and implements departmental and hospital initiated measures to control expenses. Informs and refer ED patients who are being discharged to the ED Check-out office for collection of co-pays.
- 27. Displays flexibility and open-mindedness to new or different ways of performance. Participates in the development and supports the use of clinical pathways and order sets, including those at triage.
- 28. Presents a professional image. Dresses in a professional manner with clean clothes and white coat. Wears name-badge in visible location; practices good personal hygiene and grooming; communicates clearly and positively with coworkers and positively represents Greenwich Hospital in the workplace.
- 29. Treats people that we serve and colleagues as guests. Welcomes patients, visitors and staff in a warm, friendly manner; is courteous; makes eye contact and smiles; introduces self by name and title. Consistently achieves high Press Ganey patient satisfaction scores.
- 30. Respects the privacy and confidentiality of patients, visitors and staff. Adheres to HIPAA regulations. Treats all patient related and other discussions with discretion; does not participate in gossip; does not discuss patient related information in public areas; is sensitive to issues of private space and personal dignity.
- 31. Is clinically efficient and evaluates a maximal number of patients per shift and can simultaneously manage multiple patients.
- 32. Participates in and teaches continuing education programs including ACLS and departmental programs for colleagues, nurses, paramedics and nursing assistants.
- 33. Coordinates the care of patients in the ED chest pain unit in conjunction with the attending ED physician. Arranges for the indicated medical record, evaluation, testing, and follow-up of patients in the chest pain unit.
- 34. Participates in the ED staff interview process and provide feedback concerning potential new applicants.
- 35. Attends at least 80% of the monthly ED medical staff meetings and actively participate in the discussion.
Satisfactory completion of an approved physician assistant program and certification by the National Commission on the Certification of Physician Assistants.
Preferred (1) one year of experience in emergency medicine
Licensure & Certification: Licensed as PA in Connecticut and certificates to dispense controlled substances by the federal Drug Enforcement Agency and a permit issued by the Connecticut Department of Consumer Affairs. Three (3) months.
Certification and skills that are described in basic and advanced cardiac life support, advanced trauma life support (audit a course within two years of employment), and pediatric advanced life support are examples of some of the skills required. Successful completion of a sexual assault forensic examiner (SAFE) course within a year of employment. The ability to use the computer for patient tracking and patient management, including order entry and discharge instruction preparation. .
MMR is required. Varivax (chicken pox vaccine) or evidence of prior chicken pox is required. Hepatitis B (or signed declination) is required for those with potential exposure to blood/body fluids.
Tdap and influenza vaccination are strongly encouraged.
The Emergency Department is a very busy and stressful work area that requires multi-tasking and constant interruptions with resultant need to re-prioritize the work plan. The patient volume-to-medical provider ratio is high. The patient service excellence demands are high. Physician assistants may be exposed to infectious diseases and issues related to sudden and unexpected deaths with its associated stress. Routinely works with scalpels, suture needles, syringe needles for injection and other sharps.
There is a considerable amount of walking, bending and stooping during rotating daytime, evening, and nighttime shifts. The ability to work for 12-hours in a standing position is needed. There is a moderate amount of assisting with lifting objects and patients ranging from five (5) to (300) three hundred pounds. Performing basic life support, including the ability to perform chest compressions is required. There is a considerable amount of fine motor control required for medical procedures (such as suturing, applying splints, and use of slit lamp).
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