Trends in ED hospital admissions and wait times by provider type after APP growth: A review of NHAMCS data from 2004 to 2021.

Authors

Tyler Roshak, Michael R Jiroutek, Melissa A Holland, Susan Avila Misciagno

Published in

JAAPA : official journal of the American Academy of Physician Assistants. Volume 39. Issue 9. Pages e10-e19. Sep 01, 2026. Epub Aug 25, 2026.

Abstract

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.
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.
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.
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.

PMID:
42647679
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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