title: Relative productivity of nurse practitioner and resident physician care models in the pediatric emergency department.
abstract: OBJECTIVE
  Duty hour restrictions limit the use of resident physicians in pediatric emergency departments (PEDs). We sought to determine the relative clinical productivity of PED attending physicians working with residents compared with PED attending physicians working with nurse practitioners (NPs).
  
  
  METHODS
  In a tertiary care PED with multiple care models (PED attending physicians with residents and/or fellows, PED attending physicians with NPs, PED attending physicians alone), we identified periods when care was provided concurrently and exclusively by a PED attending physician with 1 to 2 residents (resident pod) and a PED attending physician with 1 NP (NP pod). Billing records were reviewed to determine relative value units (RVUs) generated and patients seen by each PED attending physician. Emergency Severity Index (ESI) triage scores were used to compare patient acuities.
  
  
  RESULTS
  The NP pods generated 5.35 RVUs per hour and the resident pods generated 4.35 RVUs per hour, with a significant difference of 1.00 RVUs per hour (95% confidence interval, 0.19-1.82). The NP pods saw 2.18 patients per hour, whereas the resident pods saw 1.90 patients per hour. This difference of 0.28 was not statistically significant (95% confidence interval, -0.07 to 0.62). Patient acuity was similar. Thirteen percent of the NP pod patients had the highest triage severity levels of ESI-1 and ESI-2, whereas 19% of the resident pod patients were ESI-1 and ESI-2 (P = 0.06).
  
  
  CONCLUSIONS
  Pediatric emergency department attending physicians in an NP care model had greater clinical productivity, measured by RVUs, than PED attending physicians in a resident care model while treating similar patient populations.
authors: From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE; and †Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors: William M
authors: WM
authors: McDonnell
authors: Pamela
authors: P
authors: Carpenter
authors: Kammy
authors: K
authors: Jacobsen
authors: Howard A
authors: HA
authors: Kadish
mesh_terms: D004526:Efficiency; D004636:Emergency Service, Hospital; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D008962:Models, Theoretical; D064701:Pediatric Nurse Practitioners; D015895:Relative Value Scales; D012189:Retrospective Studies