The last two decades have seen an explosion of advanced practice providers (APPs) caring for patients in emergency departments (EDs) across the country.

APPs may be nurse practitioners or physician assistants, and they are increasingly caring for more and more complex patients in our nation’s EDs. In 2009, the last year for which these data have been reported, 15% of ED visits were managed at least in part by an APP, and 40% of these visits were managed by an APP alone.1 Both numbers are likely higher now, as is the total number of annual ED visits, which was reported by the Centers for Disease Control and Prevention to be greater than 136 million in 2011.2 When deployed thoughtfully, APPs are extremely valuable and important extensions of the clinical workforce that can improve ED throughput and enhance the patient experience while maintaining the ED quality of care that our patients expect and deserve. When deployed without careful thought and without clear expectations for consultation and the level of supervision, the quality and safety of patient care can suffer. It is our responsibility to be certain that APPs practicing in emergency care settings have appropriate and available backup from emergency physicians, who are ideally physically present with them in the care unit. When this is not feasible, harnessing the power of telemedicine is a useful tool to provide this resource remotely. It is also our responsibility to engage APPs in our continuing medical education activities to allow for their professional development and longitudinal learning, which will be of long-term benefit to our mutual patients.



  1. Brown DF, Sullivan AF, Espinola JA, Camargo CA Jr. Continued rise in the use of mid-level providers in US emergency departments, 1993-2009. Int J Emerg Med 2012;5:21.
  2. Centers for Disease Control and Prevention. Emergency department visits. Available at: (accessed May 6, 2016).


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Written By


David FM Brown, MD

Professor, Harvard Medical School, Chair, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA