Advanced Practice Provider Utilization in Acute Care Surgery: A National Survey of the Society of Acute Care Surgery Division Chiefs

INTRODUCTION: Advanced practice providers (APPs) have important roles in trauma, surgical critical care (SCC), and emergency general surgery (EGS), but their specific utilization, staffing patterns, and clinical responsibilities remain poorly characterized. This study aims to assess APP integration within US acute care surgery (ACS) programs. METHODS: A survey was distributed to division chiefs (12/2024) via the Society of ACS chiefs, assessing APP staffing, service coverage, procedures performed, patient-to-APP ratios, onboarding, and educational support. Descriptive statistics were used to analyze responses. RESULTS: 57 of 74 (77%) ACS division chiefs responded, predominantly from university (63%), level-I centers (81%). All centers had trauma, SCC, and EGS. Nearly all centers (96%) had daytime APP coverage, 49% nighttime, 86% weekends, and 70% covered holidays. The median number of APPs per center was 14, with most assigned to trauma (n = 5, interquartile range [IQR], 3-9), SCC (n = 3, IQR, 0-7), then EGS (n = 2, IQR, 0-4). Maximum patient-to-APP ratios were highest in trauma (median 11, IQR, 7.5-12) and lowest in SCC (median 6, IQR, 4.8-6). Procedures performed by APPs included chest tubes (trauma: 59.6%; SCC: 54.4%) and central lines (trauma: 43.9%; SCC: 66.7%). In addition, 24.6% of trauma and 40.4% of EGS APPs assisted in the operating room. CONCLUSIONS: The role of APPs in ACS continues to expand with nearly all centers surveyed having daytime APP coverage. However, less than half had nighttime coverage. Understanding limitations to night staffing and future efforts to define optimal APP integration, training, intraoperative support, and workload may improve standardization, efficiency, and care of our injured patients.