Document Type

Article

Publication Date

2-1-2017

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Critical Care Medicine

Volume 45, Issue 2, February 2017, Pages e132-e137.

The published version is available at DOI: 10.1097/CCM.0000000000002055 Copyright © Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

Abstract

OBJECTIVE: To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU.

DESIGN: Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013.

SETTING: Large urban academic university hospital.

SUBJECTS: One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19.1%) and 936 resident-staffed medical ICU admissions (80.9%).

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data obtained included age, gender, race, medical ICU admitting diagnosis, location at time of ICU transfer, code status at ICU admission, and severity of illness using both Acute Physiology and Chronic Health Evaluation II scores and a model for relative expected mortality. Primary outcomes compared included ICU mortality, in-hospital mortality, medical ICU length of stay, and post-ICU discharge hospital length of stay. Patients admitted to the nurse practitioner-staffed medical ICU were older (63 ± 16.5 vs 59.2 ± 16.9 yr for resident-staffed medical ICU; p = 0.019), more likely to be transferred from an inpatient unit (52.0% vs 40.0% for the resident-staffed medical ICU; p = 0.002), and had a higher severity of illness by relative expected mortality (21.3 % vs 17.2 % for the resident-staffed medical ICU; p = 0.001). There were no differences among primary outcomes except for medical ICU length of stay (nurse practitioner-resident-staffed 7.9 ± 7.5 d vs resident-staffed medical ICU 5.6 ± 6.5 d; p = 0.0001). Post-hospital discharge to nonhome location was also significantly higher in the nurse practitioner-ICU (31.7% in nurse practitioner-staffed medical ICU vs 23.9% in resident-staffed medical ICU; p = 0.24).

CONCLUSIONS: We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.

Available for download on Thursday, February 01, 2018

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