Through the last 20 years, APPs have assumed more independence in patient management in the ED, and in some EDs, it is now possible to measure patient care separately for the two types of practitioners. However, to maintain consistency, the EDBA productivity formula has not changed.

The results of the 2014 EDBA data survey are presented in Table 1.

(click for larger image) Table 1. Patients Seen Per Hour in the EDBA Data Survey for Calendar Year 2014

Staffing Ratios

Nurse staffing ratios indicate there are about 0.62 patients managed per nurse-staffed hour per day. That ratio has been very consistent over five years and also across the different volume and types of EDs. Table 2 presents the staffing ratios of all groups of ED staff since 2010.

(click for larger image) Table 2. Patient-Per-Hour Staffing Ratios Over the Last 5 Years of EDBA Surveys

The second columns of Table 1 and Table 2 reflect the use of support staff in the ED. Combining tech and clerk hours, the service ratio averaged about 1.7 patients per scheduled hour. There has been an increase in this ratio over the last five years. This may reflect the decreased number of hours staffed by clerks as the use of physician computerized order entry and other technologies has expanded.

Emergency physician staffing produced an average of 2.48 patients seen per hour. When attending physician coverage was supplemented by APPs and the APP hours were given a factor of 0.5 (as above), the staffing ratio averaged 1.97 patients per hour.

Table 3 focuses on the productivity of physicians and APPs in all the cohorts of EDs over the last four years. There has been an increasing number of EDs utilizing APP staffing. Those that use APPs appear to be increasing the number of hours relative to physician staffing. This staffing change may facilitate the continued increase in ED volume across all cohorts. But APP staffing has the greatest impact on the relative productivity of emergency physicians in EDs with over 20,000 volume per year.

(click for larger image) Table 3. Licensed Independent Practitioner Patient-Per-Hour Staffing Changes Through the Years

From the data, it appears that emergency physician productivity is slowly increasing. This could be attributed to increasing ED presence of APPs, who assist in overall patient flow. But many EDs appear to be better able to accommodate the loss of physician productivity from the implementation of electronic tools in the ED. Many emergency physicians have documented the loss of productivity and difficulties in patient flow when information systems do not support the role of physicians and APPs. There are perhaps now some signs that providers have adapted to the use of those systems.