Trends in ED hospital admissions and wait times by provider type after APP growth

Objectives: This study aimed to assess the annual proportion of emergency department (ED) visits resulting in hospital admission and to compare mean ED wait times before seeing a provider among patients cared for by a physician only, an advanced practice provider (APP) working with a physician, or an APP only from 2004 through 2021. Methods: A retrospective, cross-sectional analysis was conducted using data from the CDC's National Hospital Ambulatory Medical Care Survey–Emergency Department (NHAMCS-ED) from 2004 to 2021. Results: Hospital admission rates were comparable for visits managed by physicians only (12.7%; 95% CI, 11.9-13.4) and by APPs with physicians (12.8%; 95% CI, 11.8-13.8), whereas visits managed by APPs alone were associated with lower observed admission rates (2.4%; 95% CI, 1.9-2.9). Mean wait times were similar across provider types, averaging 43.8 minutes for physician-only visits, 44.6 for APP-physician visits, and 42.5 for APP-only visits. Conclusions: APPs practicing independently admitted patients at a lower rate than physicians alone and APPs with physicians, consistent with claims. Across the study period, all provider types saw a reduction in mean wait times, suggesting improved access to emergency care for patients.