美国急诊部 2010 年至 2017 年期间的医师助理和执业护士使用情况。

Physician assistant and nurse practitioner utilization in U.S. emergency departments, 2010 to 2017.

机构信息

Department of Emergency Medicine, University of California San Francisco, Fresno, United States of America.

出版信息

Am J Emerg Med. 2020 Oct;38(10):2060-2064. doi: 10.1016/j.ajem.2020.06.032. Epub 2020 Jun 28.

DOI:10.1016/j.ajem.2020.06.032

PMID:33142175

Abstract

BACKGROUND

Physician Assistants (PAs) and Nurse Practitioners (NPs) are widely utilized in United States (US) Emergency Departments(EDs). We sought to characterize ED PA and NP utilization and practice characteristics in US EDs 2010-2017.

METHODS

A retrospective, secondary analysis of the Center for Disease Control's National Hospital Ambulatory Medical Care Survey was performed. National estimates of ED visits involving PAs/NPs alone (PA/NP), PAs/NPs with physician involvement (PA/NP+), or physician only (PHYS) were analyzed for patient demographics and hospital characteristics.

RESULTS

Between 2010 and 2017, 1 billion US ED visits occurred. 8.4% (±4.2%) of visits were seen by a PA/NP, and 11.8% (±4.5%) by a PA/NP+; 76.3% (±7.2%) by PHYS. There was an increase in utilization by PA/NP observed in 2016. PA/NP acuity was highest for semi-urgent/nonurgent (53.2%, ±8.6%). PA/NP see the minority of ambulance arrivals [5.4% (±1.2%)] and admit less patients overall [1.6% (±0.7%)]. Less laboratory [53.6% (±10.0%) vs. 67.0% (±6.2%)] and radiographic [38.0% (±7.0%) vs. 51.6% (±4.6%)] studies were performed during PA/NP only vs. PHYS visits. PA/NP visits were most common for patients 25-44 years old (yo) (31.1%, ±5.5%) and 0-15 yo (23.9%, ±4.7%). Most PA/NP visits result in a length of stay (LOS) between 1 and 1.9 h (33.4%, ±5.7%) compared to most PHYS visits resulting in a LOS greater than 3 h (40.3%, ±3%).

CONCLUSIONS

From 2010 to 2015, PA/NP utilization remained stable until an increase in 2016. There was a decrease in 2017. Various PA/NP patient characteristics are significant compared to PHYS. PHYS continue to see most ED patients.

摘要

背景

医师助理（PA）和执业护士（NP）在美国急诊部（ED）中被广泛应用。我们旨在描述 2010 年至 2017 年美国 ED 中 PA 和 NP 的使用情况和实践特点。

方法

采用疾病控制中心国家医院门诊医疗调查的回顾性二次分析。对仅涉及 PA/NP（PA/NP）、PA/NP 与医生共同参与（PA/NP+）或仅医生（PHYS）的 ED 就诊患者的人口统计学和医院特征进行了全国性估计。

结果

在 2010 年至 2017 年间，美国 ED 就诊人次达 10 亿次。8.4%（±4.2%）的就诊者由 PA/NP 治疗，11.8%（±4.5%）由 PA/NP+治疗；76.3%（±7.2%）由 PHYS 治疗。2016 年观察到 PA/NP 利用率增加。PA/NP 的紧急程度最高为半紧急/非紧急（53.2%，±8.6%）。PA/NP 接诊的救护车到达患者较少[5.4%（±1.2%）]，总体住院人数较少[1.6%（±0.7%）]。PA/NP 就诊患者的实验室检查[53.6%（±10.0%）比 67.0%（±6.2%）]和放射学检查[38.0%（±7.0%）比 51.6%（±4.6%）]较少。与 PHYS 就诊相比，PA/NP 就诊最常见于 25-44 岁（±5.5%）和 0-15 岁（±4.7%）的患者。大多数 PA/NP 就诊的留观时间（LOS）在 1 至 1.9 小时之间（33.4%，±5.7%），而大多数 PHYS 就诊的 LOS 大于 3 小时（40.3%，±3%）。