Why the lack of improvement? The application of information technologies appears to have stalled the improvement in professional productivity, and the overall ability to see patients has been stable over the last six years. The technology must be simplified to place medical orders in the hospital systems, provide past medical records, and assist in documentation on patient care to improve the work capabilities of emergency physicians.
However, the mix is changing. Very few emergency departments that see less than 20,000 annual volume have APPs in their staffing mix. But above that number, most emergency departments now have APPs as a growing percentage of the professional hours. Table 2 shows that over the last seven years, the professional mix has increasingly featured work hours by APPs.
Emergency departments that use APPs for staffing now comprise 62 percent of all EDBA emergency departments. More important, in 2010, the APPs worked about 53 percent of the physician staffing hours. That means an emergency department that had an average of 60 emergency physician hours a day also had about 32 APP hours. In 2016, the APP hours comprised 64 percent of the emergency physician hours. That means that today, the same emergency department would now have 38 APP hours accompanying the 60 physician hours.
The most effective patient flow appears to increasingly favor the team use of emergency physicians and APPs to manage ED patients in emergency departments that see more than 20,000 patients per year. The EDBA data have followed the trend toward increasing use of APPs in the emergency department.
- Wiler JL, Welch S, Pines J, et al. Emergency department performance measures update: proceedings of the 2014 Emergency Department Benchmarking Alliance consensus summit. Acad Emerg Med. 2015;22(5):542-553.