Advertisement

Outcomes of daytime nurse practitioner–staffed versus resident-staffed nonsurgical intensive care units: A retrospective observational study

Published:November 29, 2021DOI:https://doi.org/10.1016/j.aucc.2021.10.004

      Abstract

      Background

      Rapid developments in medical care—such as monitoring devices, medications, and working hours restrictions for intensive care personnel—have dramatically increased the demand for intensive care physicians. Therefore, nurse practitioner (NP)–staffed care is becoming increasingly important. This study was aimed to compare the outcomes of daytime NP-staffed and daytime resident-staffed nonsurgical intensive care units (ICU).

      Methods

      We retrospectively assessed patients admitted to a nonsurgical ICU from March 2017 to December 2017. We collected basic patient data, including age, sex, admission diagnosis, transferring unit, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Primary endpoints were ICU mortality, hospital mortality, and 30-day mortality. Secondary endpoints were 48-h readmission, discharge to nonhome locations, and lengths of ICU and hospital stay.

      Results

      A total of 838 subjects were analysed: 334 subjects in the NP-staffed group and 504 in the resident-staffed group. The NP-staffed group was more likely to come from inpatient units (38.3% vs 16.5% for resident-staffed group; p < 0.001) and had lower disease severity (APACHE II score, 13.9 ± 8.4 vs 15.1 ± 8.2 for resident-staffed group; p = 0.047). After adjusting for age, sex, location before ICU admission, APACHE II score, and significantly different basic characteristics, there were no differences in ICU mortality, hospital mortality, or 30-day mortality between the two groups. Secondary analysis showed the NP-staffed group had a lower discharge rate to nonhome locations (2.1% vs 6.3%; p = 0.023) and shorter hospital stay (12.1 ± 14.1 vs 14.2 ± 14.3 days; p = 0.015).

      Conclusions

      We observed no difference in mortality between daytime NP-staffed and resident-staffed nonsurgical ICUs. Daytime NP-staffed care is an effective, safe, feasible method for staffing nonsurgical ICUs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ibsen B.
        The anaesthetist's viewpoint on the treatment of respiratory complications in poliomyelitis during the epidemic in Copenhagen, 1952.
        Proc Roy Soc Med. 1954; 47: 72-74
      1. Current world population. 2021, Jan
        • Adhikari N.K.
        • Fowler R.A.
        • Bhagwanjee S.
        • Rubenfeld G.D.
        Critical care and the global burden of critical illness in adults.
        Lancet (London, England). 2010; 376: 1339-1346
        • Fleischmann C.
        • Scherag A.
        • Adhikari N.K.
        • Hartog C.S.
        • Tsaganos T.
        • Schlattmann P.
        • et al.
        Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations.
        Am J Respir Crit Care Med. 2016; 193: 259-272
        • Kleinpell R.M.
        • Grabenkort W.R.
        • Kapu A.N.
        • Constantine R.
        • Sicoutris C.
        Nurse practitioners and physician assistants in acute and critical care: a concise review of the literature and data 2008-2018.
        Crit Care Med. 2019; 47: 1442-1449
        • Kleinpell R.
        • Blot S.
        • Boulanger C.
        • Fulbrook P.
        • Blackwood B.
        International critical care nursing considerations and quality indicators for the 2017 surviving sepsis campaign guidelines.
        Intensive Care Med. 2019; 45: 1663-1666
        • Milstein A.
        • Galvin R.S.
        • Delbanco S.F.
        • Salber P.
        • Buck Jr., C.R.
        Improving the safety of health care: the leapfrog initiative.
        Effect Clin Pract: ECP. 2000; 3: 313-316
        • Joffe A.M.
        • Pastores S.M.
        • Maerz L.L.
        • Mathur P.
        • Lisco S.J.
        Utilization and impact on fellowship training of non-physician advanced practice providers in intensive care units of academic medical centers: a survey of critical care program directors.
        J Crit Care. 2014; 29: 112-115
        • Pastores S.M.
        • Halpern N.A.
        • Oropello J.M.
        • Kostelecky N.
        • Kvetan V.
        Critical care organizations in academic medical centers in north America: a descriptive report.
        Crit Care Med. 2015; 43: 2239-2244
        • Kawar E.
        • DiGiovine B.
        MICU care delivered by PAs versus residents: do PAs measure up?.
        JAAPA. 2011; 24: 36-41
        • Gershengorn H.B.
        • Wunsch H.
        • Wahab R.
        • Leaf D.
        • Brodie D.
        • Li G.
        • et al.
        Impact of nonphysician staffing on outcomes in a medical ICU.
        Chest. 2011; 139: 1347-1353
        • Scherzer R.
        • Dennis M.P.
        • Swan B.A.
        • Kavuru M.S.
        • Oxman D.A.
        A comparison of usage and outcomes between nurse practitioner and resident-staffed medical ICUs.
        Crit Care Med. 2017; 45: e132-e137
        • Landsperger J.S.
        • Semler M.W.
        • Wang L.
        • Byrne D.W.
        • Wheeler A.P.
        Outcomes of nurse practitioner-delivered critical care: a prospective cohort study.
        Chest. 2016; 149: 1146-1154
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Huang M.H.
        • Hsieh H.Y.
        • van de Mortel T.
        The impact of the addition of nurse practitioners to surgical intensive care units: a retrospective cohort study.
        Aust Crit Care. 2019; 32: 244-248
        • Kerlin M.P.
        • Small D.S.
        • Cooney E.
        • Fuchs B.D.
        • Bellini L.M.
        • Mikkelsen M.E.
        • et al.
        A randomized trial of nighttime physician staffing in an intensive care unit.
        N Engl J Med. 2013; 368: 2201-2209
        • Lee J.
        • Rogers F.
        • Rogers A.
        • Horst M.
        • Chandler R.
        • Miller J.A.
        Mature trauma intensivist model improves intensive care unit efficiency but not mortality.
        J Intensive Care Med. 2015; 30: 151-155
        • McMillen M.A.
        • Boucher N.
        • Keith D.
        • Gould D.S.
        • Gave A.
        • Hoffman D.
        Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.
        J Trauma Acute Care Surgery. 2012; 73: 202-208
        • Zimmerman J.E.
        • Kramer A.A.
        • Knaus W.A.
        Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012.
        Crit Care. 2013; 17: R81
        • Kerlin M.P.
        • Adhikari N.K.
        • Rose L.
        • Wilcox M.E.
        • Bellamy C.J.
        • Costa D.K.
        • et al.
        An official American thoracic society systematic review: the effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients.
        Am J Respir Crit Care Med. 2017; 195: 383-393
        • Levy M.M.
        • Evans L.E.
        • Rhodes A.
        The surviving sepsis campaign bundle: 2018 update.
        Intensive Care Med. 2018; 44: 925-928
        • Sud S.
        • Friedrich J.O.
        • Adhikari N.K.J.
        • Fan E.
        • Ferguson N.D.
        • Guyatt G.
        • et al.
        Comparative effectiveness of protective ventilation strategies for moderate and severe acute respiratory distress syndrome. A network meta-analysis.
        Am J Respir Crit Care Med. 2021; 203: 1366-1377
        • Guan W.J.
        • Ni Z.Y.
        • Hu Y.
        • Liang W.H.
        • Ou C.Q.
        • He J.X.
        • et al.
        Clinical characteristics of coronavirus disease 2019 in China.
        N Engl J Med. 2020; 382: 1708-1720
        • Kleinpell R.
        • Sessler C.N.
        • Wiencek C.
        • Moss M.
        Choosing wisely in critical care: results of a national survey from the critical care societies collaborative.
        Crit Care Med. 2019; 47: 331-336
        • Wiencek C.A.
        • Kleinpell R.
        • Moss M.
        • Sessler C.N.
        Choosing wisely in critical care: a national survey of critical care nurses.
        Am J Crit Care. 2019; 28: 434-440