A survey on implementation of physician assistants in ICUs in the Netherlands

Background: In several countries, the advanced practice provider (APP) is positioned as a clinician in an acute care setting. In the Netherlands, physician assistants (PAs), the equivalent of the APP, are increasingly being employed in ICUs. It is unknown to what extent PAs are present in Dutch ICUs, what they do and how they are appreciated. To provide a general overview, we conducted a survey.

Methods: The survey was sent to intensivists and PAs working in ICUs in the Netherlands. The survey focused on familiarity with the PA, the underlying reasons for implementation and their tasks.

Results: Sixty-five intensivists (representing 85% of all hospitals) and 43 of the 55 (78%) Dutch PAs responded. Twenty ICUs employed PAs and eight were considering doing so. In these ICUs, both intensivists and PAs were satisfied about their performance. Quality improvement and continuity of care were the main reasons mentioned for implementation. In 60% of the ICUs, the PAs performed medium complex tasks such as inserting central venous catheters, in 20% PAs performed complex tasks like treatment of unstable patients with intubation. The main reasons for not implementing PAs were: ‘the intensivist performed the care without residents’, ‘ICU care is too complex for PAs’, ‘no need for additional personnel, enough residents available’ and ‘too expensive’.

Conclusion: ICUs in the Netherlands are recognising the potential of a PA on the ICU. Especially larger ICUs are already implementing PAs. Despite this, the majority of ICUs do not yet employ PAs. Presumptions about the profession sometimes inhibit acceptance of these professionals, although PAs are highly appreciated in the ICUs where they do work.