The impact of the addition of nurse practitioners to surgical intensive care units: A retrospective cohort study

  • Min-Hsin Huang
    Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, North Dist., Tainan City, 704, Taiwan
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  • Hsiao-Yen Hsieh
    Corresponding author. Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan, No. 66, Sec. 2, Changhe Road., Annan Dist., Tainan City, 709, Taiwan. Tel.: +886 6 355 3111x2279.
    Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan, No. 66, Sec. 2, Changhe Road., Annan Dist., Tainan City, 709, Taiwan

    Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, No. 89, Wenhua 1st St., Rende Dist., Tainan City 717, Taiwan
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  • Thea van de Mortel
    Centre for Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, QLD, 4222, Australia
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      Demand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated.


      To compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team.


      We conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation.


      A total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions.


      Incorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.


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