Resource Utilization and Throughput in Pediatric Abdominal Pain among Attendings, Residents, and Advanced Practice
A G Nuwan Perera1, Robert Tisherman2, Raymond Pitetti1
1University of Pittsburgh School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania.
Insights
Advanced practice clinician (APC) encounters for pediatric abdominal pain resulted in longer lengths of stay and increased resource utilization compared to attending or resident encounters. This highlights potential areas for optimizing emergency department care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Operations
- Clinical Resource Utilization
Background:
- Emergency department (ED) clinician category may influence patient care outcomes.
- Understanding the impact of different clinician types on length of stay (LOS) and resource use is crucial for pediatric abdominal pain management.
Purpose of the Study:
- To evaluate the effect of emergency clinician category on LOS and resource utilization in children with abdominal pain.
- To compare encounters led by attending physicians, advanced practice clinicians (APCs), and supervised residents.
Main Methods:
- Retrospective chart review of 3,874 pediatric patients (4-18 years) with abdominal pain at a quaternary-care pediatric ED.
- Data collected included demographics, LOS, disposition, return visits, lab tests, radiology studies, consults, and clinician category (attending only, APC only, supervised resident).
- Statistical analyses included ANOVA, chi-squared, Kruskal-Wallis tests, and logistic regression, excluding medically complex and high-acuity cases.
Main Results:
- Advanced practice clinician (APC) encounters were 17-21 minutes longer than attending or resident encounters, controlling for covariates.
- APC encounters showed increased likelihood of consults, lab testing, and radiology studies compared to attending or resident encounters.
- No significant differences were observed in admission rates or 72-hour return visit rates across clinician categories.
Conclusions:
- Emergency clinician category, particularly APCs, is associated with increased length of stay and resource utilization in pediatric abdominal pain cases.
- Findings suggest a need for further research to optimize healthcare resource allocation and efficiency in pediatric emergency care.
- The study identifies potential targets for improving care pathways and resource management based on clinician type.
Introduction:
Our goal was to assess the impact of emergency department (ED) clinician category on length of stay (LOS) and resource utilization in children presenting with abdominal pain.
Methods:
We conducted a retrospective chart review of all subjects 4-18 years of age at a quaternary-care pediatric ED between May 2021-April 2022 presenting with a chief complaint of abdominal pain. Collected data included demographics, LOS, disposition, 72-hour return visits, lab tests and radiology studies, consults, and emergency clinician category. We defined clinician categories as attending only, advanced practice clinician (APC) only, or supervised resident encounters. Medically complex and high-acuity cases were excluded. We performed statistical comparisons with ANOVA, chi-squared, and Kruskall-Wallis tests. Binomial logistic regression addressed the effects of the covariates age, sex, race, and acuity level.
Results:
We included 3,874 episodes. Of these, 622 (16%) visits were seen by an attending only, 1,018 (26%) by APCs, and 2,234 (58%) by supervised residents. Controlling for covariates, the average APC encounter lasted 17 minutes longer than the average attending encounter (293 minutes vs 276 minutes, P < .005, 95% CI -29.9, -4.0) and 21 minutes longer than the average resident encounter (293 minutes vs 272 minutes, P <.001, 95% CI 11.4-30.6). There were no significant differences in admission rates (attending: 128/622 [20.6%]; APC: 226/1,018 [22.2%]; resident: 477/2,234 [21.4%]; P = .63), or 72-hour return rates (attending: 30/622 [4.8%]; APC: 41/1,018 [4.0%]; resident: 99/2,234 [4.4%]; P = .61). Compared to attending-only encounters, APC encounters were more likely to include a consult (127/622 [20.4%] vs 292/1,018 [28.7%]; adjusted odds ratio (aOR) 1.51, 95% CI 1.18-1.93); less likely to include a computed tomography (CT) (13/622 [2.1%] vs 7/1,018 [0.7%]; aOR 0.31, 95% CI 0.12-0.79); more likely to include a radiology study (484/622 [77.8%] vs 873/1,018 [85.8%], aOR 1.64, 95% CI 1.26-2.14); and more likely to include lab testing (329/622 [52.9%] vs 669/1,018 [65.7%], aOR 1.62, 95% CI 1.30--2.00). Compared to supervised resident encounters, APC encounters were more likely to include a consult (518/2,234 [23.2%] vs 292/1,018 [28.7%], aOR 1.35, 95% CI 1.14-1.61); less likely to include a CT (36/2,234 [1.6%] vs 7/1,018 [0.7%], aOR 0.43, 95% CI 0.19-0.98); more likely to include a radiology study (1603/2,234 [71.8%] vs 873/1,018 [85.8%], aOR 2.41, 95% CI 1.97-2.96); and more likely to include lab testing (1,230/2,234 [55.1%] vs 669/1,018 [65.7%], aOR 1.63, 95% CI 1.39-1.92). Attending-only encounters were more likely to include radiology studies compared to resident encounters (484/622 [77.8%] vs 1,603/2,234 [71.8%], aOR 1.47, 95% CI 1.18-1.83), but they were otherwise similar in diagnostic utilization.
Conclusion:
In our study of pediatric patients with abdominal pain, APC encounters had longer length of stay and were more likely to include lab testing, radiology studies, and consults than resident or attending-only encounters. This suggests that emergency clinician category may be associated with resource utilization, and further research could help optimize healthcare utilization.
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