Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, Texas and U.S. Acute Care Solutions, Canton, Ohio.
Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, Texas and U.S. Acute Care Solutions, Canton, Ohio.
J Emerg Med. 2024 Feb;66(2):240-248. doi: 10.1016/j.jemermed.2023.11.007. Epub 2023 Nov 18.
Whether integration of nurse practitioners (NPs) and physician assistants (PAs) into academic emergency departments (EDs) affects emergency medicine (EM) resident clinical learning opportunities is unclear.
We sought to compare EM resident exposure to more-complex patients, as well as patients undergoing Accreditation Council for Graduate Medical Education (ACGME)-required procedures, at nonpediatric academic EDs with lower, moderate, and higher levels of NP/PA utilization.
In this cross-sectional study of National Hospital Ambulatory Medical Care Survey (NHAMCS) data for 2016-2020, nonpediatric academic EDs were classified into the following three groups based on the percentage of patients seen by an NP or PA: lower (≤ 10%), moderate (10.1-30%), and higher (> 30%) NP/PA utilization. The proportion of EM resident-seen patients meeting previously established complex patient criteria was then determined for EDs at each level of NP/PA utilization. The proportion of EM resident-seen patients receiving certain ACGME-required procedures was also determined. Survey analytic procedures and weighting as recommended by NHAMCS were used to calculate and compare proportions using 95% CIs.
The weighted 2016-2020 NHAMCS data sets represent 44,130,996 adult resident-seen patients presenting to nonpediatric academic EDs. The proportion of resident-seen patients meeting complex patient criteria did not significantly differ for lower (43.2%; 95% CI 30.6-56.8%), moderate (41.7%; 95% CI 33.0-50.9%), or higher (38.9%; 95% CI 29.3-49.4%) NP/PA utilization EDs. The proportion of patients undergoing an ACGME-required procedure also did not significantly differ across level of NP/PA utilization.
Higher levels of NP/PA utilization in nonpediatric academic EDs do not appear to reduce EM resident exposure to more-complex patients or ACGME-required procedures.
护士从业者（NPs）和医师助理（PAs）融入学术急诊部门（EDs）是否会影响急诊医学（EM）住院医师的临床学习机会尚不清楚。
我们旨在比较非儿科学术 EDs 中 NP/PA 使用率较低、中等和较高水平下，EM 住院医师接触更复杂患者以及接受毕业后医学教育认证委员会（ACGME）要求的程序的情况。
在这项对 2016-2020 年全国医院门诊医疗调查（NHAMCS）数据的横断面研究中，根据 NP 或 PA 诊治患者的百分比，将非儿科学术 ED 分为以下三组：低（≤10%）、中（10.1%-30%）和高（>30%）NP/PA 使用率。然后确定每个 NP/PA 使用率水平的 ED 中符合先前确定的复杂患者标准的 EM 住院医师所见患者的比例。还确定了 EM 住院医师所见患者接受某些 ACGME 要求的程序的比例。使用 NHAMCS 建议的调查分析程序和加权方法，使用 95%CI 计算和比较比例。
加权的 2016-2020 NHAMCS 数据集代表了 44130996 名成年住院医师所见患者到非儿科学术 EDs 的就诊情况。符合复杂患者标准的住院医师所见患者的比例在 NP/PA 使用率较低（43.2%；95%CI 30.6-56.8%）、中等（41.7%；95%CI 33.0-50.9%）或高（38.9%；95%CI 29.3-49.4%）的 ED 中没有显著差异。接受 ACGME 要求的程序的患者比例在 NP/PA 利用率水平上也没有显著差异。
非儿科学术 EDs 中 NP/PA 使用率的提高似乎并没有减少 EM 住院医师接触更复杂患者或 ACGME 要求的程序的机会。
