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Evaluating the success of an inpatient PA and NP program through trends in ED consults
Laura Stock1, Justin Turcotte, Andrea Johnson
1At Luminis Health Anne Arundel Medical Center in Annapolis, Md., Laura Stock is an orthopedic research fellow, Justin Turcotte is director of orthopedic and surgical research, and Andrea Johnson is an orthopedic research fellow and research analyst. Samuel E. Holbert is an orthopedic research fellow at Luminis Health Anne Arundel Medical Center and a general surgery resident at the Medical University of South Carolina in Charleston, S.C. Also at Luminis Health Anne Arundel Medical Center, Matthew Siska practices in orthopedics, Karen Pipkin is an orthopedic NP and lead advanced practice provider for Luminis Health orthopedics, and Chad Patton is an attending orthopedic surgeon and medical director for spine surgery. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Objective:
We investigated the effect of an inpatient physician associate/assistant (PA) and NP program on consult volume, length of stay (LOS), and ED returns.
Methods:
A retrospective observational study of 4,118 orthopedic ED consults was conducted from January 2017 to March 2022. Univariate statistics were used to evaluate outcomes between cohorts and multivariate regression to evaluate the odds of an LOS of less than 24 hours.
Results:
After implementation of the PA and NP program, surgeon consults steadily declined and orthopedic consults increased markedly. Statistically significant differences were found in LOS of less than 24 hours and ED arrival-to-discharge time. Adjusting for case mix, patients were 47% more likely to be discharged within 24 hours. Survey results noted that more than 80% of surgeons felt on-call workload, disruptions to clinic and surgical schedules decreased, and quality of care increased.
Conclusions:
Implementation of an inpatient PA and NP program reduced orthopedic surgeon consults and hospital LOS while improving surgeon satisfaction with on-call workload, schedule disruptions, and quality of care.
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