995-2000 Trends in Emergency Department Utilization of Physician Extenders and Lower Acuity Tracks-A 5-year Longitudinal Report

Phelps Ma, Kazzi Aa, B Gee, Kim, Langdorf
Objectives: Widespread Emergency Department (ED) overcrowding and pervasive financial and managed care pressure to cut staffing costs, limit ED "cost-shifting," and streamline resource utilization promote the development of alternatives to the traditional model of ED care in which all treatment-regardless of acuity-is provided within the ED by emergency physicians. In some EDs, lower acuity patients may be triaged to a separate track within the ED (e.g., urgent care, fast track, or minor care)
more » ... ck, or minor care) and treatment may also be provided by less costly physician extenders (PEs) such as nurse practitioners (NPs) and physician assistants (PAs). This study surveys all EDs in California (CA) regarding their use of lower-acuity tracks (LATs) and physician extenders (PEs) in 2000 for comparison with data collected in 1995. Methods: Between January-December of both 1995 and 2000, brief surveys regarding ED staffing were mailed to all CA hospitals reported by the American Hospital Association as having, or potentially having an ED, and follow-up calls were made to non-responders. Results: 291/372 (78%) responded in 2000. 394/421 (94%) of EDs provided data in 1995. The 49 sites included in 1995 but not in 2000 reflect reported ED closures. LATs were found in 47% (137/291) of EDs in 2000, compared to 41% (161/394) in 1995. PEs were utilized by 46% (132/289; 2 missing) of EDs in 2000, up from 32% (125/394) in 1995. In 2000, among EDs that used PEs, 72% (95/132) used PAs and 40% (53/132) used NPs, compared to 66% (82/125) and 38% (47/125) respectively , in 1995. Among the 278 EDs that provided data for both years, there was an 11% increase in PE use [from 97 (35%) to 127 (46%)] and a 5% increase in LATs [from 119 (43%) to 134 (48%)] over the study period. Conclusions: The use of lower acuity tracks and physician extenders in the ED grew steadily from 1995 to 2000, reflecting an ongoing effort to reduce costs and shift resource utilization within emergency care.