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Differences in test ordering between nurse practitioners and attending emergency physicians when acting as Provider
Tomer Begaz1, David Elashoff2, Tristan R Grogan2
1Department of Emergency Medicine, David Geffen School of Medicine, Olive View UCLA Emergency Medicine, Sylmar, CA, United States.
This study compared how nurse practitioners and attending physicians order diagnostic tests when acting as Provider in Triage (PIT) in the emergency department. Researchers analyzed data from 770 patients who had tests ordered from the waiting room. They found that physicians ordered more test categories than NPs during triage. However, by the end of the patient's ED stay, the total number of test categories ordered was not significantly different. Patient time in the ED was also not significantly different between provider types. The authors suggest that NPs in the PIT role order fewer tests than physicians during triage without affecting patient outcomes like ED length of stay.
Area of Science:
- Emergency medicine clinical decision-making
- Healthcare provider workflow analysis
- Diagnostic testing in acute care
Background:
Emergency departments rely on diagnostic testing to guide care decisions. While attending physicians typically order these tests, nurse practitioners (NPs) may also serve in roles like Provider in Triage (PIT). Prior research has shown that provider type can influence diagnostic test ordering patterns in various clinical settings. However, the extent to which NPs and attending physicians differ in test ordering when both act as PIT remains unclear. This uncertainty drove the need for a direct comparison of diagnostic test practices between NPs and physicians in this specific role. No prior work had resolved whether NPs order fewer tests than physicians in triage without affecting patient outcomes. This gap motivated the current analysis of triage-level diagnostic test decisions.
Purpose Of The Study:
The study aimed to compare diagnostic test ordering practices between nurse practitioners and attending physicians serving as Provider in Triage (PIT). The specific problem addressed was whether provider type influences the number of diagnostic tests ordered during triage and whether this affects patient outcomes like time in the emergency department (ED). The motivation stemmed from the growing use of NPs in triage roles and the need to understand how their decisions compare to those of physicians. The study sought to clarify whether NPs order fewer diagnostic tests than physicians in this role. It also aimed to determine if such differences impact patient time in the ED. The researchers focused on test categories ordered and total tests ordered by the end of the ED stay. The goal was to assess whether NPs in triage order fewer tests without increasing ED length of stay.
Main Methods:
The study used a secondary analysis of data from a prospective randomized controlled trial involving waiting room diagnostic testing. A total of 770 patients had diagnostic tests ordered from the waiting room. The primary outcome was the number of test categories ordered by provider type. Additional outcomes included total tests ordered by the end of the ED stay and time in an ED bed. Researchers compared variables between groups using t-tests and chi-square tests. They also constructed logistic regression models for individual test categories and univariate and multivariate negative binomial models. The analysis focused on differences in test categories ordered by NPs versus physicians. The study evaluated whether provider type influenced the number of diagnostic tests ordered during triage. It also examined if these differences affected patient length of stay in the ED.
Main Results:
Physicians ordered significantly more diagnostic test categories than NPs during triage (1.75 vs. 1.54, p<0.001). By the end of the ED stay, there was no significant difference in total test categories ordered between provider types: physicians ordered 2.67 and NPs ordered 2.53 (p=0.08). The incidence rate ratio was 1.07 (0.98–1.17). Patient time in an ED bed was not significantly different between physicians and NPs (244 minutes for NPs vs. 248 minutes for physicians, p=0.688). The difference in time was only 4 minutes (-24.3 to 16.1). NPs in the PIT role ordered slightly fewer diagnostic tests than attending physicians. This difference did not affect time spent in an ED bed. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types.
Conclusions:
NPs in the Provider in Triage (PIT) role ordered fewer diagnostic test categories than attending physicians during triage. This difference did not affect patient time in the ED. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types. The authors propose that NPs in triage roles do not order excessive diagnostic tests. They suggest that PIT staffing with NPs does not lead to prolonged ED patient stays. The findings indicate that NPs may order fewer tests during triage without impacting patient outcomes. The authors emphasize that these results support the use of NPs in triage roles without compromising diagnostic efficiency. No prior work had resolved whether NPs order fewer diagnostic tests in triage without affecting ED length of stay. The authors conclude that NPs in the PIT role do not appear to order excessive diagnostic tests.
Frequently Asked Questions
NPs ordered fewer diagnostic test categories than physicians during triage, but this difference did not affect patient time in the ED.
The study used t-tests, chi-square tests, logistic regression, and negative binomial models to compare diagnostic test ordering.
The PIT role is critical for early patient assessment and diagnostic test ordering in the ED, making it a key point for comparing provider decision-making.
There was no significant difference in patient time in the ED between NPs and physicians (244 vs. 248 minutes).
No, the study found no significant difference in total test categories ordered by the end of the ED stay between provider types.
The authors suggest that NPs in the PIT role do not order excessive tests or prolong ED patient stays.
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