Comparing nurse practitioners/physician assistants and physicians in diagnosing adult abdominal pain in the emergency department

Hoyt, K. Sue; Ramirez, Elda G.; Topp, Robert; Nichols, Stephen; Agan, Donna L.

doi:10.1097/jxx.0000000000000083

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…Although the NPs and PAs working independently had reduced odds of consistent diagnoses, NPs and PAs working in collaboration with physicians had higher odds of consistent diagnoses compared with physicians working alone. The study also found that hospitals with more equal distributions of NPs/PAs and physicians with respect to those with disproportionate distributions had greater odds of consistent diagnoses for acute abdominal pain (Hoyt et al, 2018). This study underscores that full practice authority for NPs does not exclude collaborative care.…”

Section: Outcomes In Emergent Care Settingsmentioning

confidence: 83%

“…A retrospective study of over 12,000 emergency patients with an Emergency Severity Index of level 3 presenting with acute abdominal pain compared NP and PA diagnostic performance with that of physicians and with interprofessional collaboration (Hoyt et al, 2018). Although the NPs and PAs working independently had reduced odds of consistent diagnoses, NPs and PAs working in collaboration with physicians had higher odds of consistent diagnoses compared with physicians working alone.…”

Section: Outcomes In Emergent Care Settingsmentioning

confidence: 99%

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Recent evidence of nurse practitioner outcomes in a variety of care settings

Geller

Swan

2020

J Am Assoc Nurse Pract

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When nurse practitioners (NPs) work to expand their scope of practice through state legislatures, the opposing lobbying groups are often physician-led organizations. The main argument against NP independence and limited scope of practice is that NP care is inherently inferior to that of physicians. However, more than three decades of research demonstrates quality and cost outcomes to be equal to or better than that of physicians. This article reviews a wide range of evidence documenting NP competency, satisfaction, and safety, as well as the challenges and consequences when limiting NP scope of practice. The evidence is clear and has not changed in over 30 years, NPs provide access to effective primary care in a variety of settings, equal in quality outcomes, safety, and cost-effectiveness compared with physicians.

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Section: Outcomes In Emergent Care Settingsmentioning

confidence: 83%

Section: Outcomes In Emergent Care Settingsmentioning

confidence: 99%

Recent evidence of nurse practitioner outcomes in a variety of care settings

Geller

Swan

2020

J Am Assoc Nurse Pract

View full text Add to dashboard Cite

show abstract

“…Another similarly large study demonstrated that the hospitalization rates for patients with chest and abdominal pain were “largely similar after matching for severity and complexity” to physician rates (Pines et al, 2021). When looking specifically at adult patients who presented with acute abdominal pain, a study of more than 12,000 patients demonstrated no difference in the final patient disposition (admission vs. discharge) between NP and physician providers (Hoyt et al, 2018). • Patient outcomes: One large 4-year study among 94 US EDs found no adverse effects on clinical safety or patient experience among individuals treated by NPs (Pines et al, 2020).…”

Section: Outcomes Of Nurse Practitioner Care In Emergency Settingsmentioning

confidence: 99%

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes

Wilbeck¹,

Davis²,

Tyler

et al. 2023

J Am Assoc Nurse Pract

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The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patientcentered care provided by NPs in emergency care.

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“…Low-value care is particularly salient for efficiency because it reflects patient care that offers no net benefit in specific clinical scenarios—both raising costs and potentially harming patients 25 26. Prior work comparing ED NPs/PAs and physicians caring for ED patients has typically focused on single clinical conditions or single medical centres, or relied on older data, and largely has found conflicting results 27–29. One US study suggested that EDs employing NPs/PAs used more services than EDs that did not; however, this ecological work was at the ED level and could not directly compare individual NPs/PAs with physicians 30.…”

Section: Introductionmentioning

confidence: 99%

US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis

et al. 2022

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ObjectivesNurse practitioners and physician assistants (NPs/PAs) increasingly practice in emergency departments (EDs), yet limited research has compared their practice patterns with those of physicians.Design, setting and participantsUsing nationally representative data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), we analysed ED visits among NPs/PAs and physicians between 1 January 2009 and 31 December 2017. To compare NP/PA and physician utilisation, we estimated propensity score-weighted multivariable regressions adjusted for clinical/sociodemographic variables, including triage acuity score (1=sickest/5=healthiest). Because NPs/PAs may preferentially consult physicians for more complex patients, we performed sensitivity analyses restricting to EDs with >95% of visits including the NP/PA–physician combination.ExposuresNPs/PAs.Main outcome measuresUse of hospitalisations, diagnostic tests, medications, procedures and six low-value services, for example, CT/MRI for uncomplicated headache, based on Choosing Wisely and other practice guidelines.ResultsBefore propensity weighting, we studied visits to 12 410 NPs/PAs-alone, 21 560 to the NP/PA–physician combination and 143 687 to physicians-alone who saw patients with increasing age (41, 45 and 47 years, p<0.001) and worsening triage acuity scores (3.03, 2.85 and 2.67, p<0.001), respectively. After weighting, NPs/PAs-alone used fewer medications (2.62 vs 2.80, p=0.002), diagnostic tests (3.77 vs 4.66, p<0.001), procedures (0.67 vs 0.77, p<0.001), hospitalisations (OR 0.35 (95% CI 0.26 to 0.46)) and low-value CT/MRI studies (OR 0.65 (95% CI 0.53 to 0.80)) than physicians. Contrastingly, the NP/PA–physician combination used more medications (3.08 vs 2.80, p<0.001), diagnostic tests (5.07 vs 4.66, p<0.001), procedures (0.86 vs 0.77, p<0.001), hospitalisations OR 1.33 (95% CI 1.17 to 1.51) and low-value CT/MRI studies (OR 1.23 (95% CI 1.07 to 1.43)) than physicians—results were similar among EDs with >95% of NP/PA visits including the NP/PA–physician combination.Conclusions and relevanceWhile U.S. NPs/PAs-alone used less care and low-value advanced diagnostic imaging, the NP/PA–physician combination used more care and low-value advanced diagnostic imaging than physicians alone. Findings were reproduced among EDs where nearly all NP/PA visits were collaborative with physicians, suggesting that NPs/PAs seeing more complex patients used more services than physicians alone, but the converse might be true for more straightforward patients.

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Comparing nurse practitioners/physician assistants and physicians in diagnosing adult abdominal pain in the emergency department

Abstract: The highest percentage of consistent AAP ESI level 3 diagnoses between ED admission and discharge was when NPs/PAs and physicians collaborated.

Cited by 7 publications

References 23 publications

Recent evidence of nurse practitioner outcomes in a variety of care settings

Recent evidence of nurse practitioner outcomes in a variety of care settings

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes

US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis

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