Resource Utilization in Non-Academic Emergency Departments with Advanced Practice Providers.

Area of Science:

• Health Services Research
• Emergency Medicine
• Healthcare Economics

Background:

• Advanced practice providers (APPs), such as physician assistants and nurse practitioners, are increasingly integrated into emergency department (ED) staffing.
• Limited research exists on the resource utilization and cost-effectiveness of APPs in ED settings.

Purpose of the Study:

• To compare resource utilization in EDs with and without APPs.
• To estimate the costs associated with resource utilization in EDs staffed by APPs.

Main Methods:

• A five-year retrospective analysis of the Emergency Department Benchmarking Alliance (EDBA) database.
• Comparison of resource utilization rates (admissions, CT, radiography, ultrasound, MRI) per 100 visits in non-academic EDs with and without APPs.
• Cost estimation using 2014 Medicare physician fee schedules and inpatient payments, with outcomes adjusted for volume, acuity, and attending hours.

Main Results:

• EDs with APPs demonstrated higher utilization: 3.0 more admissions, 1.7 more CTs, 4.5 more radiographs, and 1.0 more ultrasounds per 100 visits.
• MRI utilization was comparable between EDs with and without APPs.
• Projected costs indicated approximately 30.4 more admissions per 1000 visits in APP-staffed EDs, potentially incurring $414,717 in utilization costs.

Conclusions:

• EDs employing APPs were associated with modest increases in resource utilization, particularly in admissions and diagnostic imaging.
• The findings highlight the need for further investigation into the economic impact and optimal integration of APPs in emergency care settings.