EMERGENCY DEPARTMENT USES OF PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS - A NATIONAL SURVEY

A study was undertaken to determine the extent to which physician assi stants (PAs) and/or nurse practitioners (NPs) are a source of health c are delivery in emergency departments (EDs) in the United States. The National Hospital Ambulatory Medical Survey (NHAMCS) uses a multi-stag e probability sample that examines patient visits within EDs. The samp le included 437 hospitals with EDs. Visits were mostly from self-refer red patients to EDs within nonfederal, short-stay hospitals, or genera l hospitals. Analysis of NHAMCS data found that a PA and/or NP was see n for 3.5 million ED visits in 1992, Remarkably little difference in g ender, reason for visit, diagnosis, and medication prescribed was foun d between PA/NP visits and visits to all providers. This was the first study that systematically identified the extent of PA/NP-delivered ED services in the United States and compared it with physician services . Overall, PAs and NPs were found to be significant sources of health care service for hospital EDs. They are involved in care for almost 4% of all ED visits nationally and manage a wider range of conditions th an has been previously reported. When types of visits are analyzed, in cluding reasons for ED care, diagnosis, and treatment, it appears that visits associated with care by ED-based PA/NPs are similar to all ED visits, including those attended by emergency medicine physicians. Mor e studies are needed to better understand the role of PAs and/or NPs i n various ED settings. Recruitment and use of PAs and NPs may be a cos t-effective strategy for improved delivery of emergency services. (Am J Emerg Med 1996;14:245-249. Copyright (C) 1996 by W.B. Saunders Compa ny)