Mid-Level Providers in the Emergency Department

May 8, 2014  |  Delia Caldwell

There has long been a tradition in emergency departments — some might even call it a bias — of relying solely on physicians and nurses as the providers of medical care. Times are changing, however, and the use of mid-level providers, particularly Physician Assistants (PAs) and Nurse Practitioners (NPs), is allowing many EDs to bring new levels of efficiency and flexibility to their operations.

Levels of Autonomy

One of the keys to understanding the impact that mid-level providers can have on efficiency is their varying levels of autonomy in the course of providing care.

For example, a PA’s license is dependent on the license of his or her supervising physician, and therefore the PA can provide care only in coordination with the physician. There is, however, some flexibility in terms of how the physician provides this oversight; some physicians provide it on a concurrent basis in simultaneous patient examinations, after which the PA can implement procedures and order tests per the physician’s guidance. In other cases, the physician can provide the oversight in retrospective reviews.

Consider another mid-level provider: the Nurse Practitioner. An NP’s license is independent from that of the attending physician, so they have the same abilities to order tests and treatment that PAs do, but without the need to coordinate care decisions with the physician in real time, or even retrospectively.

Relieving the Burden

Some emergency departments are also using mid-level providers in the triage function, to order tests and treatment per protocol; others are stationing mid-level providers in lower acuity areas where they can work in rapid assessment roles.

Incorporating mid-level providers into the operational flow, with a focus on treating lower acuity patients, allows physicians to focus on treating sicker patients — and therefore allows everyone to perform to their highest and best use. Using mid-level providers can be a key strategy in operating lean, helping EDs to maintain a more consistent level of patient care, and managing greater throughput.

 ABOUT THE AUTHOR     Delia Caldwell MBAoutcome_swarming_Delia Caldwell
Delia Caldwell works with clinical staff to put the systems and processes in place they need to improve care and save lives. Through simulation modeling, process mapping, and dashboard tools she helps departments reduce LOS, improve patient outcomes, and streamline operations. A skilled facilitator, Delia guides organizations through change, using data to demonstrate that her recommendations will improve productivity and efficiency. With more than 85 operational studies completed, her efforts have redefined the way that providers deliver care. Read more from Delia.

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