Phys Asst, Cardiac Surgery
The Phys Asst, Cardiac Surgery in cardiac surgery functions to support the practice of the attending surgeons and intensivists.
The scope of practice will comply with all state, federal and local laws. Their practice will also be subject to the regulations and bylaws of the hospital and medical staff Specifically, as delineated in chapter 35 of the Board of Medical Examiners of NJ, chapter 2B- NJ 13:35-2B.4. This is paraphrased below. 1. Performance and documentation of a complete medical history and physical exam. Formulate a list of problems from this information, coupled with any available diagnostic tests and imaging studies. Formulate a preliminary therapeutic plan for these problems. This information will be presented to an attending physician for generation of a final therapeutic plan for which the midlevel provider will then help to execute. 2. Assisting the attending medical staff with daily inpatients care. The Physician Assistant will perform daily rounds on all patients; review this information with the attending physician, then document the patient's status in the medical record along with the plan of care. The midlevel provider will then facilitate carrying out the agreed upon plan. 3. Provide education and counseling of the patients as directed and requested by the attending physician staff. 4. Routine wound care including suture closure and suture removal, dressing changes and other wound care protocols as dictated by the attending physician. 5. Other procedures not explicitly delineated above, but which are requested by the supervising physician and which are with the scope of practice of a /PA as appropriate. The PA may perform the following procedures when directed by a supervising physician, or as part of approved protocol: 1. Performance of invasive and noninvasive laboratory studies, or assisting appropriately licensed personnel in their performance. 2. Medication administration including IV, SQ or IM injections. 3. The PA in either an inpatient, or outpatient, setting may order and/or prescribe medication in accordance with defined protocols or MD direction. Such prescribing must conform to all applicable law and regulation. 4. A physician assistant may assist a supervising surgeon in the operating room when a qualified assistant physician is not required by the board of medical examiners and a second assistant is deemed necessary by the supervising surgeon. 5. Supervision of the PA will be in accordance with all applicable law and regulations including constant electronic communication with responsible attending physicians. Personal physician review and countersignature on all appropriate work within 24 hours (inpatient), and 48 hours (outpatient). 6. The charts and notes of the physician assistant will be periodically reviewed for quality and performance improvement. 7. The physician assistant will receive a written evaluation every 6 months from the chief of cardiac surgery. Within the various treatment areas the clinical duties specific for physician assistants with the division of Cardiac Surgery at Hackensack University Medical Center and The heart and Vascular Hospital will be as follows: Cardiothoracic Operating Room: 1. Insures that all appropriate imaging data (Cardiac Caths, echocardiograms, radiographs, etc) are immediately available for review by the Surgeon. 2. Assists other OR personnel in bladder catheterization, the positioning of the patient, and proper prepping for a surgical field. 3. Assists the physician staff with insertion of monitoring catheters. 4. harvest and preparation of saphenous vein for coronary artery bypass grafting including use of endoscopic techniques; removal of radial artery for use as bypass conduit; function as first, second, or third assistant in all phases of surgery. 5. Insure all appropriate intraoperative data in transmitted both, to the section of data management in the division, and the patients chart. Cardiothoracic Intensive Care Unit: 1. Presents the patients on morning rounds to the team. Helps to formulate and carry out the therapeutic plan for the day. Cares for the patient as directed by the physician staff including dressing changes, modification of medication regimes, phlebotomy when needed, orders diagnostic studies as determined appropriate by the team and collects and presents the resultant data to the attending physician team. 2. Inserts and removes monitoring lines and chest tubes as requested by the supervising physician. 3. Assists or initiates CPR/arrest protocols. 4. Participates in the daily charting. 5. Admits patients to the CTICU. 6. Adjusts ventilator settings and supervises weaning protocols. 7. Adjusts epi-cardial pacemakers. 8. Assists physician during insertion and removal of intra-aortic balloon pump and other bedside surgical procedures, which will include emergent sternotomy, bronchoscopy, tracheotomy, etc. Cardiothoracic step down unit/floor 1. First call responsibility for all floor patients under the supervision of the attending surgeon and intensivists. 2. Reinsert of remove tracheostomies as warranted. 3. Initiate pacing when necessary. 4. Tracheal intubation when necessary emergently or in conjunction with the anesthesia department depending on the clinical scenario. 5. Follows all outlying patients who are on the service but not on our floor. 6. Preliminary evaluation of all consults called into the department followed by presentation to the attending staff. Additional night and weekend duties 1. First-call responsibility for patients on the Cardiothoracic Service. 2. Admits new patients and institutes pre-op procedures including: history and physical exam, confirms blood supply for the next day's surgical patients, provides an X-ray for each patient on the surgical schedule, assists in obtaining the consent for surgery, and evaluates all blood work to confirm that there is nothing that prohibits a patient from going to surgery. 3. Remains available for any emergency OR procedures that require assistance. 4. Responds to Emergency Room requests involving chest trauma or evaluation for possible admission to the CTS service. 5. Evaluates all requests for Cardiac surgical consults and presents the case to the attending surgeon. Additional Responsibilities 1. Provide coverage at affiliate and partnership locations when requested.
Education, Knowledge, Skills and Abilities Required: 1. Successful completion of an approved physician's assistant program, accredited by the AMA Education, Knowledge, Skills and Abilities Preferred: 1. The ability to concentrate for prolonged periods, work well under stress and be able to think clearly and decisively in emergencies. 2. A willingness to take night, weekend and holiday call. 3. Knowledge of surgical anatomy, cardiothoracic surgical procedures, ECG, and hemodynamic monitoring interpretation. 4. Ability to harvest venous and arterial conduit, preferably by both open and endoscopic techniques. Licenses and Certifications Required: 1. Physician Assistant License. 2. Certification by the National Commission for Certified PhysicianÂ¿s Assistants (NCCPA) within one year of initial employment by the Medical Center. 3. BCLS, ACLS - within first two years of employment. Licenses and Certifications Preferred: 1. AHA Basic Health Care Life Support HCP Certification or Advanced Cardiac Life Support Certification.
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