Study objectives: With our “changing” medical environment, the addition of physician extenders is becoming common practice. It is conceptualized that they help reduce expenses and improve patient through time while reducing costs. We determine whether use of physician assistants (PA) reduces emergency department (ED) length of stay without a negative effect on patient satisfaction.

Methods: This was a retrospective cohort study in a university-affiliated hospital located in suburban New Jersey, with an ED residency and annual ED census of 65,000 visits. Patients presenting to our combined fast track/pediatric ED, open 16 hours a day, were included. Equivalent days were chosen to approximate similar ED patient volumes. A retrospective analysis of data collected from an ED tracking system was based on consecutive patients treated in our ED on Thursday/Sunday and Tuesday/Saturday. Each coupled day uses a different staffing model. Our ED “standard model” (DR) is composed of single-physician coverage for 16 hours combined with a second emergency physician coverage for 12 hours. Our “interventional group” (PA) is composed of the same 16 hours of emergency physician coverage with the addition of 24 hours (2 overlapping 12-hour shifts) of PA coverage. Patient satisfaction scores were based on totaled averages of received Press Gainy scores (RVU=relative value unit). Analysis was preformed on each group respectively. All tests of statistical significance were conducted at ⍺ equal to 0.05.

Results: Analysis of 44 different days was performed, totaling 3,836 patient encounters. There were 1,876 patients enrolled in the DR model and 1960 in the PA model.

Conclusion: ED length of stay was not reduced with the PA model compared with the DR model. No significant improvements were noted in the PA model with regard to billing or patient satisfaction score, although there was a higher acuity on PA days.
Table, abstract 131.DRPAP ValueTotal visits18761960NSMean age, y25.024.8NSMean acuity level2.983.08.002Admissions/day2.553.77NSMean length of stay, min111113NSMean RVU/patient1.631.62NSMale sex, %5554NSPatient satisfaction90.888.3NSNS, Not significant.