Introduction
Advanced practice providers (APP), including physicians’ assistants and nurse practitioners, have been increasingly incorporated into emergency department (ED) staffing over the past decade. There is scant literature examining resource utilization and the cost benefit of having APPs in the ED. The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources.
Methods
In this five-year retrospective secondary data analysis of the Emergency Department Benchmarking Alliance (EDBA), we compared resource utilization rates in EDs with and without APPs in non-academic EDs. Primary outcomes were hospital admission and use of computed tomography (CT), radiography, ultrasound, and magnetic resonance imaging (MRI). Costs were estimated using the 2014 physician fee schedule and inpatient payments from the Centers for Medicare and Medicaid Services. We measured outcomes as rates per 100 visits. Data were analyzed using a mixed linear model with repeated measures, adjusted for annual volume, patient acuity, and attending hours. We used the adjusted net difference to project utilization costs between the two groups per 1000 visits.
Results
Of the 1054 EDs included in this study, 79% employed APPs. Relative to EDs without APPs, EDs staffing APPs had higher resource utilization rates (use per 100 visits): 3.0 more admissions (95% confidence interval [CI], 2.0–4.1), 1.7 more CTs (95% CI, 0.2–3.1), 4.5 more radiographs (95% CI, 2.2–6.9), and 1.0 more ultrasound (95% CI, 0.3–1.7) but comparable MRI use 0.1 (95% CI, −0.2–0.3). Projected costs of these differences varied among the resource utilized. Compared to EDs without APPs, EDs with APPs were estimated to have 30.4 more admissions per 1000 visits, which could accrue $414,717 in utilization costs.
Conclusion
EDs staffing APPs were associated with modest increases in resource utilization as measured by admissions and imaging studies.
Background
: Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the COVID-19 pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVI) and related respiratory conditions.
Methods:
Observational study of ED encounters in a 11-hospital system in BLINDED during 2019-2020. Year-on-year ratios for all complaints were calculated to account for ‘lockdowns’ and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history.
Results:
There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend towards an association between the year-on-year ratio for all ED visits and the BLINDED stay-at-home order (parameter estimate=-0.0804, p=0.10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for non-COVID viral illness and exacerbations of asthma exacerbations and COPD, respectively (p<0.001 for all).
Conclusions:
These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons.
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