A provider-only patient care protocol was safe and efficient for delivery of emergency department (ED) care in response to pandemic-related staff shortages, based on data from nearly 3000 patients.
The COVID-19 pandemic sparked a shortage of healthcare personnel, according to Tanveer Gaibi, MD, of INOVA Fairfax Hospital, Falls Church, Virginia, and colleagues. To help manage these challenges, the INOVA emergency department developed a Provider-Only Patients (POP) protocol for patients who required minimal nursing care.
In a study presented at the American College of Emergency Physicians (ACEP) 2022 Scientific Assembly, the researchers reported the outcomes of a cohort of patients with suspected COVID-19 who were treated in the emergency department using the POP between Dec. 1, 2021, and Jan. 15, 2022. The patients ranged in age from 21 to 64, and all presented with COVID-19-related complaints, with an Emergency Severity Index (ESI) of 4 or 5, with 1 being the most urgent and 5 being the least urgent.
Patients were triaged by a physician or nurse to determine POP status. Those deemed POP patients were seen and discharged directly by a physician or advanced practice provider (APP). The researchers reviewed data from a total of 640 patients treated via POP and 2386 non-POP patients with ESI of 4 or 5.
Overall, the mean time from when a patient was initially seen by a provider to the discharge disposition was 48 minutes shorter for POP patients, and the mean time from discharge disposition placement to leaving the ED was 66 minutes shorter. None of the POP patients were readmitted within 72 hours of discharge. The researchers estimated that the 640 patients in the POP protocol saved approximately 1892.27 hours of nursing and 705.1 provider hours during the study period, and no additional physician hours or advanced practice provider hours were needed.
The study findings suggest that POP holds up as a safe, efficient, and effective process that can reduce discharge length of stay and provider to disposition times. Although more research is needed, the POP model also may be considered to address staffing challenges unrelated to the pandemic, the researchers concluded.
“This study was conducted at [a] time when our emergency department was experiencing a sudden and disproportionate increase in volume related to the Omicron variant of COVID-19,” Gaibi told Medscape. “This novel process was developed by brainstorming untested ways of managing this increased demand. The research study was a natural outcome once the process was implemented,” he said.
“Once barriers to implementing this process were overcome, we were not surprised by the results,” Gaibi said. “Subtracting at the time for nursing process was anticipated to shorten cycle times.”
The clinical implications of POP relate to generalizability outside of the pandemic setting, Gaibi noted. “We anticipate that POP could be used for patients with minor complaints to greatly shorten their time in the emergency department,” he said.
“Potential barriers to the generalized use of POP relate, in part, to local administrative barriers related to nursing assessments,” Gaibi explained. “Further, POP patients should be simple and require little or no testing. Keeping to this strict definition of the provider only patient may be a pitfall in terms of its hard wiring,” he added.
Looking ahead, more research is needed to study POP in ED patients with minor complaints not necessarily related to COVID-19, Gaibi said.
The study received no outside funding. The researchers disclosed no relevant financial relationships.
American College of Emergency Physicians (ACEP) 2022 Scientific Assembly: Abstract 88. Presented October 2022.
Heidi Splete is a freelance medical journalist with 20 years of experience.