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Wichita EM

PA/NP Collaboration Guidelines

Supervising Physician List

(Last revised 5/2025)


  • The ED Physician collaborative patient evaluation guidelines outlined below are at the discretion of the ED physician.
  • The NP/PA may request the ED physician to collaboratively evaluate any patient at any time during the patient’s ED course.
  • The NP/PA is to time and document ED physician collaboration as specified below.

Basic Guidelines

Section titled “Basic Guidelines”

  • Suspicious history and/or exam not consistent with radiology interpretation (concern for radiology discrepancy)

  • Unplanned patient returns to ED within 72 hours

  • ESI Level 1 (red)

  • Notify Medical Director of respective campus of any unanticipated patient death in the ED

  • Involve ED physician as early and often as possible in anticipated ICU admissions and ill or concerning patient presentations

Admission Guidelines

Section titled “Admission Guidelines”

  • All admissions to specialist services – discuss with ED Physician prior to call

  • Includes anyone except Sound, Family Practice, Med 1, Ortho, Surgery, OB/GYN, Urology.

  • Psychiatric admissions excluded from collaboration if vitals normal.

  • A physician must document a note on all patients admitted to an ICU.

Adult Guidelines (> 18 yo)

Section titled “Adult Guidelines (> 18 yo)”

  • Abdominal pain > 60 yo that the NP/PA plans to discharge home

  • Unexplained, persistent abnormal vital signs including tachycardia

  • Syncope > 40 yo that the NP/PA plans to discharge home

Cardiopulmonary Guidelines

Section titled “Cardiopulmonary Guidelines”

  • Non-specific and atraumatic chest pain > 40 yo that the NP/PA plans to discharge home

  • Pulmonary embolism that the NP/PA plans to discharge home

  • Patients with a suspected or confirmed arterial injury or occlusion

Neurologic Guidelines

Section titled “Neurologic Guidelines”

  • CVAs/TIAs within 24 hours of symptoms. If stroke alert activated, the patient needs to be seen with ED physician.

  • New focal and/or neurological deficit

  • Intractable headache

  • Acute spinal fracture

  • Acute skull fracture

OB Guidelines

Section titled “OB Guidelines”

  • Ectopic pregnancy

  • Precipitous delivery

  • ALL patients greater than 20 weeks gestation (discuss immediately with physician)

Ortho Guidelines

Section titled “Ortho Guidelines”

  • Open fractures except open finger/toe tuft fractures

  • Fracture with skin tenting

  • Felon

  • Tenosynovitis

  • Muscle laceration

  • Tendon laceration

  • ED physician to interpret all plain film radiology not interpreted by a radiologist (e.g. overnights)

Pediatric Guidelines (< 18 yo)

Section titled “Pediatric Guidelines (< 18 yo)”

  • Fever < 60 days old (ED physician is to be made aware of these patients immediately)

  • Pediatric complaints < 3 months of age

  • Syncope < 18 yo that the NP/PA plans to discharge home

Psych Guidelines

Section titled “Psych Guidelines”

  • Suicidal or homicidal ideation that the NP/PA/LCSW plan to discharge. If telepsychiatry recommendation is to discharge home, can dismiss without collaboration with ED physician.

  • Significant impairment from drugs or alcohol

  • Patients with unexplained vital sign abnormalities

  • HR > 110 or Systolic B/P < 90

Specialist Guidelines

Section titled “Specialist Guidelines”

NP/PA may call after discussion with ED physician

Section titled “NP/PA may call after discussion with ED physician”

  • Neurosurgery

  • Oral Surgery

  • Plastic surgery

  • Ophthalmology

  • Trauma (If APP is not ATLS certified, patient needs to be seen by ED physician.)

  • Vascular

  • Cardiothoracic Surgery

  • Anesthesiology

  • Emergent specialist intervention required in the ED - discuss with ED physician.

Procedures

Section titled “Procedures”

NP/PA Procedures WITH Collaboration of ED Physician:

Section titled “NP/PA Procedures WITH Collaboration of ED Physician:”
  • Lumbar Puncture
  • Thoracentesis
  • Central Venous Access
  • Needle Decompression/Tube Thoracostomy
  • Emergent Pericardiocentesis
  • Endotracheal Intubation
  • Neuromuscular Blockade
  • Mechanical Ventilation
  • Cardioversion/Defibrillation/CPR
  • Cardiac Pacing - External/Transthoracic
  • Gastric Lavage
  • Moderate Sedation
  • Deep Sedation

NP/PA Procedures WITHOUT Collaboration of ED Physician:

Section titled “NP/PA Procedures WITHOUT Collaboration of ED Physician:”
  • Local Anesthesia
  • Incision and Drainage of Cutaneous Abscesses
  • Wound Management and Repair
  • Local Anesthesia
  • Incision and Drainage of Cutaneous Abscesses
  • Wound Management and Repair
  • Nasogastric/Orogastric Tube Insertion
  • Epistaxis Control
  • Arterial Sampling of Blood Gas Analysis
  • Fracture/Dislocation Immobilization
  • Closed Reduction of Fracture or Dislocation
  • Nursemaid’s Elbow Reduction
  • Nail Trephination
  • Joint Injection/Arthrocentesis
  • Splint Placement
  • Removal of Splints/Casts
  • IV Placement
  • Slit/Wood’s Lamp Exam with or without Foreign Body Removal
  • Tonometry
  • Bladder Catheterization
  • Replacement of Suprapubic Catheters and PEG Tubes
  • Digital Nerve Blocks
  • Foreign Body Removal
  • Mild Procedural Sedation Including Nitrous Oxide (with approval)
  • Perform ECG
  • Cervical Immobilization/Clearing of C-Spine Immobilization
  • Ultrasound for ED Procedures/ED Emergencies
  • Contrast Injection for Imaging

Supervising Physician List

Section titled “Supervising Physician List”