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Fig. 1
Trends in ED visits seen by MLPs with or without direct physician involvement (1993-2005). Physician assistant visits without physician involvement (solid circle) shows slope of 0.002 (95% CI, 0.001-0.003). Nurse practitioner visits without physician involvement (solid square) shows a slope of 0.001 (95% CI, 0.0003-0.001). Physician assistant visits with physician involvement (empty circle) shows a slope of 0.002 (95% CI, 0.001-0.004). Nurse practitioner visits with physician involvement (empty square) shows a slope of 0.001 (95% CI, 0.0001-0.001).
Abstract
Objective
The aim of the study was to evaluate use of physician assistants (PAs) and nurse practitioners (NPs) in US emergency departments (EDs).
Methods
We analyzed visits from the 1993 to 2005 National Hospital Ambulatory Medical Care Survey, seen by midlevel provider (MLP), and compared characteristics of MLP visits to those seen by physicians only.
Results
From 1993 to 2005, 5.2% (95% CI, 4.6%-5.8%) of US ED visits were seen by PAs and 1.7% (95% CI, 1.5%-2.0%) by NPs. During the study period, PA visits rose from 2.9% to 9.1%, whereas NP visits rose from 1.1% to 3.8% (both Ptrend < .001). Compared to physician only visits, those seen only by MLPs arrived by ambulance less frequently (6.0% vs 15%), had lower urgent acuity (37% vs 59%), and were admitted less often (3.0% vs 13%).
Conclusions
Midlevel provider use has increased in US EDs. Their involvement in some urgent visits and those requiring admission suggests that the role of MLPs extends beyond minor presentations.
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Abstract presented at the 2008 American College of Emergency Physicians Scientific Assembly (Chicago, IL).
