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Advanced Practice Clinicians and Emergency Department Flow

August 25, 2020

Written by Nicole McCoin

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We need to closely examine how best to utilize advanced practice providers (APPs) in our ED staffing models. In settings where APPs are treating lower complexity patients, APP coverage does not have a negative impact on clinical quality or patient experience. Authors noted higher APP coverage allowed physicians to see higher acuity cases but did not seem to lower staffing costs.

Why does this matter?
There has been a great increase in the use of APPs in the recent past. In 2008, 1 in 12 patient encounters were managed by a PA and 1 in 18 were managed by a NP. In 2016, these numbers increased to 1 in 6 and 1 in 8 by a PA and NP, respectively. Given this rapid increase, we need to understand how best to incorporate them into ED staffing models to optimize ED workflow, costs, and, most importantly, patient care.

We need more data.
This large study of over 13 million patients across 94 emergency departments (EDs) between 2014-2018 showed:

  • APPs treated lower complexity patients.

  • APPs treated half as many patients per hour as doctors.

  • Increasing APP staffing does not seem to lower staffing costs.

On the flip side:

  • There was no observable effect of APP coverage on ED flow.

  • There was no significant effect of APP coverage on clinical quality.

  • There was no significant effect of APP coverage on patient experience.

I am hopeful there will be even more studies examining productivity, staffing costs, clinical quality, and patient experience in settings where there are different models of APP staffing (e.g. higher acuity patient complaints; working in triage; creative patient treatment models utilizing the physician and APP together). We need this data to make the best decisions regarding ED staffing.

The Impact of Advanced Practice Provider Staffing on Emergency Department Care: Productivity, Flow, Safety, and Experience. Acad Emerg Med. 2020 Jul 7. doi: 10.1111/acem.14077. [Epub ahead of print]

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What are your thoughts?