The Impact of Advanced Practice Provider Staffing on Emergency Department Care: Productivity, Flow, Safety, and Experience

Abstract

After reading the article, participants should be able to discuss the productivity of advanced practice providers (APPs). Activity Disclosures This activity received no commercial support. CME Editor Corey Heitz discloses no relevant financial relationships. This activity underwent peer review in line with standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.'s Policy on Activity Disclosure and Conflict of Interest. Accreditation John Wiley and Sons, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within 1 hour. To successfully earn credit, participants must complete the activity during the valid credit period, which is up to two years from initial publication. Additionally, up to 3 attempts and a score of 70% or better is needed to pass the post test.

Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain

“…A third limitation is that study outcomes were chosen based primarily on utilization (i.e., decision to order a test or admit) rather than other outcomes, such as patient experience or clinical outcomes. However, our prior exploratory work examining these outcomes did not identify differences in incident reports, 72‐hour returns, or patient experience with higher use of APPs 7 …”

“…Visits that were comanaged by APPs and physicians were excluded. For APPs, we analyzed PAs and NPs together as a group rather than separately because in our prior work, we detected no differences in the impact of PAs and NPs on quality of care, flow, or patient safety 7 . We excluded visits of patients who left without treatment, left against medical advice, were dead on arrival, or died in the ED.…”

“…However, some EDs have local policies where APPs must present specific cases to physicians. In those cases, it is common for the physician and APP to document the case which in our prior work only occurred in 1.4% of cases 7 . In this study, those cases were excluded.…”

“…APP clinical education is considerably shorter and less specialized (i.e., 2 years of general medical education) compared to ED physician education (i.e., 4 years of general medical education and 3 to 4 years of specialized graduate medical education in emergency medicine) raising concerns that the limited exposure of APPs to content and mentored supervision might lead to differences in practice and patient safety concerns. Prior work by our research team has demonstrated that in a national emergency medicine group, a care model combining increasing APP use with focused educational programs along with local emergency physician oversight had no impact on ED flow, quality of care, or outcomes but also did not provide economies of scale in staffing costs 7 …”

The Economics and Effectiveness of Advanced Practice Providers Are Decidedly Local Phenomena

“…In this issue of Academic Emergency Medicine, Pines and coauthors 9 attempt to address many previously unanswered questions in the areas of both economics and effectiveness, although the study’s main endpoints are economic. Primarily using a data set of visits across 94 EDs in 19 states staffed by U.S.…”