Physician Assistant Week is October 6-12, 2013. We are reminded of a most remarkable case that originated with a Physician Assistant (PA), as so many remarkable stories do.

A retired man balanced carefully on a ladder. He was changing a garage door spring. The tensioned spring was one of those very strong springs that lift the door. He lifted his arms to position the spring. The spring snapped and dragged a large hook through his arm. The man lived 40 miles from the nearest hospital, a critical access hospital. The emergency room was staffed by a PA. We have worked with this PA over the years in many roles. He is a smart and dedicated man with good judgment. He was being supervised by local primary care physicians.

The consultation began as a phone call. Thanks to an Appalachian Regional Commission Grant, an early form of iClickCare® was installed in this emergency room. How quaint it seems now - not only not on a mobile device but there was no cell service. Yet, how effective this store-and-forward telemedicine was, even “back in the day.”  After a brief telephone conversation during which the indescribable was halfway described; pictures were taken, a brief history noted, a button clicked, and the hand surgeon was virtually in the emergency room within a few seconds at a hospital over one hour away. 

Care was begun.

• First, tell the patient an amputation was not necessary. It had been considered.
• Second, the Emergency Department was notified by a second click. The department was prepared for the patient's arrival. “Throughput”, not a term at the time, was 17 minutes.
• Third, a click, and the Operating Room was prepared. The anesthesiologist was informed. Equipment, tables, sutures, and personnel were assembled. 

Two hours of surgery (the case went well), another hour in recovery, and the patient went home. Hand therapy followed. Other PAs and students shared the case for learning, months and years later. A short video, securely stored in iClickCare, shows full function.

So who won here?

• The Patient received ACCESS to the proper care at the proper time. Moreover, he spent the entire trip in the ambulance during transfer, not looking at the roof and mourning the loss of his arm, but knowing the plan for repair. And he was back home in bed the same day. A video conference was not needed with the suffering patient holding his hemorrhaging arm up in front of a face-to-face video conference camera in a special room with expensive equipment.

• The Emergency Room COLLABORATED by anticipating and enabling the proper triage, orders and flow without making the patient wait for re-examination, wound observation and chasing down the specialist.

• The Operating Room spent the transfer time quietly preparing without stress of the unknown.

• The Anesthesiologist, who wishes only to relieve pain, did not have to inflict pain to examine the wound. 

• The surgical Specialist battened down the hatches, saved hours of visits, assessment, rounds the next day. He was not paid for the consultation. He would not have been anyway, but, he was paid for the surgery.

• The Originating Hospital provided good care, with good supervision, and allowed the Physician Assistant to practice medicine in a legally compliant, and even more importantly, a confident and comfortable way.

• The Accepting Hospital provided coordinated, cost effective care on a Saturday afternoon. If collaborative care is cost effective, which it is, the Hospital made out in spades!

• The Hand therapist also had benefit of an intra-operative photograph. She knew what was strong, what was weak, and her treatment plan was adjusted accordingly.

The Physician Assistant is the hero of this story.
He began, and eventually followed, the patient’s journey. Because he bothered to care, and not ship, because he took an extra minute or two for medical collaboration, because he was doing his everyday job with everyday excellence, he helped everyone. Since he then could follow the results, he could go home after his long shift, weeks later, satisfied and knowing, instead of worrying and wondering. EDUCATION.

ClickCare recognizes and congratulates all Physician Assistants. We hope that PAs will learn more about iClickCare so that they may, as the American Academy of Physician Assistants defines, be “health professionals licensed or, in the case of those by the federal government, credentialed, to practice medicine with physician supervision."

Access, Collaboration, and Education. We all need it.

Be sure to visit the ClickCare Homepage to find out about Healthcare Community Events you might want to attend, and to read the latest in telemedicine in this week's American Telemedicine Association (ATA) Newsbrief.

If you are a PA, and have your own story to tell, please let us know. If there are topics you would like to see us cover as a blog article, or have opinions about this blog article, please DO comment.