Resource Utilization and Throughput in Pediatric Abdominal Pain among Attendings, Residents, and Advanced Practice Clinicians.

INTRODUCTION: Our goal was to assess the impact of emergency department (ED) clinician category on length of stay (LOS) and resource utilization in children presenting with abdominal pain. METHODS: We conducted a retrospective chart review of all subjects 4-18 years of age at a quaternary-care pediatric ED between May 2021-April 2022 presenting with a chief complaint of abdominal pain. Collected data included demographics, LOS, disposition, 72-hour return visits, lab tests and radiology studies, consults, and emergency clinician category. We defined clinician categories as attending only, advanced practice clinician (APC) only, or supervised resident encounters. Medically complex and high-acuity cases were excluded. We performed statistical comparisons with ANOVA, chi-squared, and Kruskall-Wallis tests. Binomial logistic regression addressed the effects of the covariates age, sex, race, and acuity level. RESULTS: We included 3,874 episodes. Of these, 622 (16%) visits were seen by an attending only, 1,018 (26%) by APCs, and 2,234 (58%) by supervised residents. Controlling for covariates, the average APC encounter lasted 17 minutes longer than the average attending encounter (293 minutes vs 276 minutes, P < .005, 95% CI -29.9, -4.0) and 21 minutes longer than the average resident encounter (293 minutes vs 272 minutes, P <.001, 95% CI 11.4-30.6). There were no significant differences in admission rates (attending: 128/622 [20.6%]; APC: 226/1,018 [22.2%]; resident: 477/2,234 [21.4%]; P = .63), or 72-hour return rates (attending: 30/622 [4.8%]; APC: 41/1,018 [4.0%]; resident: 99/2,234 [4.4%]; P = .61). Compared to attending-only encounters, APC encounters were more likely to include a consult (127/622 [20.4%] vs 292/1,018 [28.7%]; adjusted odds ratio (aOR) 1.51, 95% CI 1.18-1.93); less likely to include a computed tomography (CT) (13/622 [2.1%] vs 7/1,018 [0.7%]; aOR 0.31, 95% CI 0.12-0.79); more likely to include a radiology study (484/622 [77.8%] vs 873/1,018 [85.8%], aOR 1.64, 95% CI 1.26-2.14); and more likely to include lab testing (329/622 [52.9%] vs 669/1,018 [65.7%], aOR 1.62, 95% CI 1.30--2.00). Compared to supervised resident encounters, APC encounters were more likely to include a consult (518/2,234 [23.2%] vs 292/1,018 [28.7%], aOR 1.35, 95% CI 1.14-1.61); less likely to include a CT (36/2,234 [1.6%] vs 7/1,018 [0.7%], aOR 0.43, 95% CI 0.19-0.98); more likely to include a radiology study (1603/2,234 [71.8%] vs 873/1,018 [85.8%], aOR 2.41, 95% CI 1.97-2.96); and more likely to include lab testing (1,230/2,234 [55.1%] vs 669/1,018 [65.7%], aOR 1.63, 95% CI 1.39-1.92). Attending-only encounters were more likely to include radiology studies compared to resident encounters (484/622 [77.8%] vs 1,603/2,234 [71.8%], aOR 1.47, 95% CI 1.18-1.83), but they were otherwise similar in diagnostic utilization. CONCLUSION: In our study of pediatric patients with abdominal pain, APC encounters had longer length of stay and were more likely to include lab testing, radiology studies, and consults than resident or attending-only encounters. This suggests that emergency clinician category may be associated with resource utilization, and further research could help optimize healthcare utilization.

Duke Scholars

Author Jennifer Dunnick Pediatrics, Emergency Medicine