Emergency Medicine Australasia (2014) 26, 651–652


Re: NEAT in need of a sweet spot Dear Editor, I read with interest the article by Keijzers.1 National Emergency Access Targets (NEAT) are now in our public EDs to improve access block associated with unnecessary mortality. By 2015, 90% of all patients presenting to the ED will be required to be discharged, admitted to hospital or transferred to another facility for care.1,2 Keijzers reports that the background of NEAT is based on overcrowding and prolonged ED length of stay can be associated with poorer outcomes that indicate suboptimal care.1 The importance of Keijzers’ article is that it reports that quality of care can be difficult to measure and suggests research that focuses on process and time variable.1 Keijzers suggests the use of evidence-based markers outlined by the Institute of Medicine but does not suggest how these markers will be measured or how they will improve quality care. 1 Many EDs measure quality by the number of risks reported associated with treatment delays, medications errors, medical errors and worst of all mortality.

The article highlighted that ED staff aim to provide high-quality, evidencebased care but NEAT is not evidence based, I would argue that.1 With sufficient research and with the implementation NEAT mandated by the National Health Reform one could suggest that our Emergency Clinicians are practicing evidence-based medicine.2 It is clear to say that there are some concerns with patients being moved just before they breach to meet a target.3 I suggest that further studies to determine mortality associated with patients who are moved closer to the cut-off time have different outcomes to others. The article identified that we need new evidence-based research on quality measures and defining NEAT ‘sweet spots(s)’ to empower our administrators and politicians and I suggest that a new NEAT measure is required.1 Achieving the 4 h rule requires organisational ownership and support.1–3 Failure to achieve this will produce negative effects on staff, impact on process improvement and risk to patients.

Competing interests None declared.

References 1. Keijzers G. NEAT in need of a sweet spot. Emerg. Med. Australas. 2014; 26: 217–8. 2. Khanna S, Boyle J, Good N, Lind J. New emergency department quality measure: from access block to National Access Target compliance. Emerg. Med. Australas. 2013; 25: 565– 72. 3. Weber EJ, Mason S, Carter A, Hew RL. Emptying the corridors of shame: organizational lessons from england’s 4-hour emergency throughput target. Ann. Emerg. Med. 2011; 57: 79– 88.

Holly Louise WARDLAW Department of Emergency Medicine, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia doi: 10.1111/1742-6723.12303

Physician assistants and emergency care: Augmenting the workforce Dear Editor, We read with great interest ‘Midlevel providers and emergency care: Let’s not lose the force’ by Judith Tintinalli.1 Dr Tintinalli raises some important points that warrant expansion regarding emergency medicine physician assistants (EMPAs). Since 1990 the Society of Emergency Medicine Physician Assistants (SEMPA) is the exclusive profession-

al organisation representing physician assistants (PAs) in emergency medicine. SEMPA’s mission is to promote and support the professional, clinical and personal development of PAs involved with emergency medicine and to advance the practice of emergency medicine. Our members practice in various settings including academic medical centres, community medical centres, trauma centres,

rural hospitals and urgent care centres. SEMPA works closely with stakeholder organisations including the American Academy of Physician Assistants, National Commission on Certification of Physician Assistants (NCCPA) and the American College of Emergency Physicians (ACEP). We have multiple liaisons serving on committees within these organisations. ACEP is our management organisa-

© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine



tion, a relationship that enhances our partnership with the largest group of emergency physicians. The term ‘mid-level provider’ is outdated and does not accurately reflect our practice. SEMPA has a policy statement addressing our professional title to more accurately reflect our clinical role. SEMPA-recognised terms are ‘physician assistant’ (PA) or ‘emergency medicine physician assistant’ (EMPA). SEMPA believes other terms attempting to combine nurse practitioners and PAs to be confusing and misleading to our patients and legislators. Should PAs be referred to collectively with other non-physician providers, the term ‘Advanced Practice Provider (APP)’ is also recognised. ACEP has adopted the APP title. In the past several years, PA specialty certification in emergency medicine has been offered by the NCCPA through the Certificate of Added Qualification (CAQ). CAQ candidates must demonstrate advanced knowledge and experience in emergency medicine. Requirements for certification also include 150 h of Category 1 Continuing Medical Education in emergency medicine, at least 3000 h of practice experience, attestation from a supervising emergency physician that the PA is competent in emergency medicine procedures/patient care and successful completion of a written exam. Recertification is required every 10 years.

As EMPAs comprise a larger part of the emergency medicine workforce, institutions have developed formal postgraduate EMPA Fellowships (residencies). Currently, 26 such programmes exist in the United States. The 12- to 24-month programmes include structured didactic sessions along with clinical work in the ED and other related specialties (e.g. pediatric emergency medicine, trauma, critical care, anaesthesia, etc.). They are modelled after emergency medicine physician residency training and SEMPA will soon release a guideline addressing core programme training standards. SEMPA is the leader in EMPA education. SEMPA 360, our annual educational conference, brings together leading emergency medicine educators and EMPAs. Additional SEMPA courses in development include an emergency airway cadaver lab and emergency ultrasound course. SEMPA and ACEP have partnered to offer a threephase ‘Emergency Medicine Academy’ focusing on basic emergency medicine principles, emergency procedures and critical care emergency medicine. Industry partners offer discounts on educational programmes for our membership. As Dr Tintinalli has written, there is a need for EMPA education and SEMPA is committed to meeting it. SEMPA is on the forefront of EMPA educational, legislative, practice and advocacy issues. Policies and guidelines de-

veloped by SEMPA address issues such as the CAQ, EMPA title, postgraduate training and clinical practice guidelines and are available for reference at our website http://www.sempa .org. Additionally, SEMPA does not support the independent practice of any APP. In closing, SEMPA believes emergency physicians are not ‘losing the workforce’ by partnering with PAs in their ED, but rather augmenting the practice to provide accessible, safe, quality emergency care to our patients.

Competing interests None declared.

Reference 1. Tintinalli J. Mid-level providers and emergency care: let’s not lose the force. Emerg. Med. Australas. 2014; 26: 403–7.

Frederick WU1 and Thomas CHAMBERS2 1 Department of Emergency Medicine, Kaweah Delta Medical Center, Visalia, California, USA, and 2Department of Emergency Medicine, Sutter Roseville Medical Center, Roseville, California, USA doi: 10.1111/1742-6723.12316 FW and TC are both authors based on the ICMJE criteria.

© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

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