Length of Stay and Return Visits for Abdominal Pain: Advanced Practice Providers vs Physicians

Advanced practice providers (APPs; nurse practitioners and physician assistants) are increasingly integrated into emergency departments (EDs) to address crowding and workforce shortages; however, their impact on throughput for patients with undifferentiated abdominal pain remains uncertain. The objective of this study was to compare ED length of stay and short-term return visits for patients with undifferentiated abdominal pain initially managed by APPs versus physicians.

We conducted a retrospective cohort study of adult ED visits for abdominal pain at two University of Utah Health emergency departments (January 2020–January 2025). Visits were categorized by the initial clinician of record (APP vs physician). The primary outcome was emergency department length of stay (ED-LOS), analyzed using a generalized linear model with a Gamma distribution and log link. The secondary outcome was the rate of unplanned 7-day return visits among discharged patients, analyzed using multivariable logistic regression. All models adjusted for demographics, triage Emergency Severity Index (ESI), initial vital signs, ED site, and door-to-doctor time.

Among 17,046 visits, 14,155 (83.0%) were initially managed by physicians and 2,891 (17.0%) by APPs. The median LOS was 6.1 hours (IQR 4.5–8.1). In the adjusted analysis, APP-managed visits were associated with a 6.3% longer overall ED-LOS compared to physician-managed visits (ratio 1.063; 95% CI 1.046–1.081; p<0.001). However, among discharged patients (n=9,795), APP management was associated with a 7.2% shorter adjusted ED-LOS (ratio 0.928; 95% CI 0.913–0.942; p<0.001). Unplanned 7-day return visits occurred in 4.3% of discharged patients, with no significant difference by provider type (adjusted OR 1.09; 95% CI 0.87–1.36; p=0.46).

For abdominal pain visits, APP management was associated with modestly longer LOS overall but shorter LOS among discharged patients, with similar 7-day return visit rates. Findings suggest comparable short-term outcomes and highlight the influence of case mix and disposition when evaluating ED staffing models.