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Comparing nurse practitioners/physician assistants and physicians in diagnosing adult abdominal pain in the emergency department

Hoyt, Karen Sue PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN (Professor NP/DNP Programs)1; Ramirez, Elda PhD, RN, FNP-BC, ENP-C, FAAN, FAEN, FAANP (Professor, Clinical Nursing and Director of Emergency/Trauma Nurse Practitioner Concentration)2; Topp, Robert PhD, RN (Professor and Patricia A. Chin Endowed Chair)1; Nichols, Stephen MD (Chief of Clinical Operations Performance)3; Agan, Donna EdD (Data Scientist and Instructor)1

Journal of the American Association of Nurse Practitioners: November 2018 - Volume 30 - Issue 11 - p 655–661
doi: 10.1097/JXX.0000000000000083
Research - Quantitative

Background and purpose: This retrospective study compared nurse practitioners and physician assistants (NPs/PAs) with physicians on their assignment of Emergency Severity Index level 3 (ESI level 3) acute abdominal pain (AAP) in the emergency department (ED).

Methods: Data obtained from a large ED group staffing four hospitals yielded 12,440 de-identified, adult patients diagnosed on ED admission with AAP ESI level 3 for descriptive analysis with logistic regression.

Conclusions: Results revealed that the comparison of ESI level 3 AAP diagnoses was consistent between admission and discharge 95.3% for physicians, 92.9% for NPs/PAs, and 97.1% for NP/PA and physician collaboration (χ2 = 46.01, p < .001). Logistic regression suggested that NP/PA had significantly reduced odds (31%) of consistent admitting/discharge diagnoses, whereas collaboration of NP/PA with physicians had significantly increased odds of consistent diagnosis (41%) compared with physicians alone. Two hospitals with similar distributions of NPs/PAs and physicians exhibited greater odds of consistent diagnoses over hospitals with disproportionate distributions; a secondary finding worth exploring. Consistent AAP ESI level 3 diagnoses by outcomes were admissions (>99%), discharges (94%), and left against medical advice/transferred (98%; χ2 = 102.94, p < .001).

Implications for practice: The highest percentage of consistent AAP ESI level 3 diagnoses between ED admission and discharge was when NPs/PAs and physicians collaborated.

1Hahn School of Nursing and Health Science, Beyster Institute of Nursing Research, University of San Diego, San Diego, California,

2University of Texas Health Science Center Houston, Houston, Texas,

3Emergency Medicine & Hospital Medicine, Schumacher Group, Lafayette, Louisiana

Correspondence: Karen Hoyt, PhD, RN, FNP-BC, ENP-C, FAEN, FAANP, FAAN, University of San Diego, 5998 Alcala Park, San Diego, CA 92110. E-mail:

Competing interests: The authors report no conflicts of interest.

Received March 24, 2018

Received in revised form May 01, 2018

Accepted May 08, 2018

© 2018 American Association of Nurse Practitioners
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