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West J Emerg Med. 2013 Nov;14(6):598-601. doi: 10.5811/westjem.2012.12.12848.

Mid-level Providers Working in a Low-acuity Area are More Productive than in a High-acuity Area.

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St. Luke's University Hospital and Health Network, Bethlehem, Pennsylvania.



Mid-level providers (MLP) are extensively used in staffing emergency departments (ED). We sought to compare the productivity of MLPs staffing a low-acuity and high-acuity area of a community ED.


This is a retrospective review of MLP productivity at a single center 42,000-volume community ED from July 2009 to September 2010. MLPs staffed day shifts (8AM-6PM or 10AM-10PM) in high- and low-acuity sections of the ED. We used two-tailed T-test to compare patients/hour, relative value units (RVUs)/hour, and RVUs/patient between the 2 MLP groups.


We included 49 low-acuity and 55 high-acuity shifts in this study. During the study period, MLPs staffing low-acuity shifts treated a mean of 2.7 patients/hour (confidence interval [CI] +/- 0.23), while those staffing high-acuity shifts treated a mean of 1.56 patients/hour (CI +/- 0.14, p<0.0001). MLPs staffing low-acuity shifts generated a mean of 4.45 RVUs/hour (CI +/- 0.34) compared to 3.19 RVUs/hour (CI +/- 0.29) for those staffing high-acuity shifts (p<0.0001). MLPs staffing low-acuity shifts generated a mean of 1.68 RVUs/patient (CI +/- 0.06) while those staffing high-acuity shifts generated a mean RVUs/patient of 2.05 (CI +/- 0.09, p<0.0001).


MLPs staffing a low-acuity area treated more patients/hour and generated more RVUs/hour than when staffing a high-acuity area.

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