Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis

Abstract

Objective Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls. Methods The composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group. Results A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35–0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09–2.2, p = 0.015). Conclusion Acute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.

Advanced practice providers in critical care improve team performances. A post-hoc analysis of the BASIC trial

“…Recent research on APPs in critical care often focused on the evaluation of clinical patient-related outcomes and performances of these APPs in conjunction with a coordinating medical specialist. (2)(3)(4) In this study the non-technical skills of APPs and residents as leaders of a RRT were assessed without this additional consultation. APPs performed better than residents in several subcategories and omitted overall less predefined critical steps.…”

Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis

“…This study compared an APP-led rapid response team with a resident-led rapid response team. This study found no differences between the groups except for a shorter in-hospital stay of the patients visited by the APP-led group but after propensity matching [ 13 ]. The study mainly focused on patient outcomes and less on process outcomes.…”

“…Apparently, so far, an optimal composition and implementation of a rapid response team has not yet been established [ 8 , 19 ]. This fact and the lack of validated measurement tools except for the MAELOR tool probably explains why the literature reports different success rates and struggles with aligning outcome data when reporting on the performance of rapid response teams [ 3 , 8 , 13 , 20 , 21 ].…”

“…A third, retrospective single center study comparing outcome data of rapid response teams led by a nurse practitioner and by a registrar showed an improved hospital mortality in the nurse practitioner -led group after propensity matching. This study mainly reported patient outcomes [ 13 ].…”

Advanced Practice Providers as Leaders of a Rapid Response Team: A Prospective Cohort Study

“…At the moment, the optimal composition of an RRT is not yet known; the evaluation of rapid response teams emphasizes experience rather than a certain composition, although involvement of intensive care professionals may be beneficial [ 13 , 14 , 15 ]. A recent study using propensity score matching found that the participation of an APP in an RRT resulted in a decreased length of hospital stay [ 16 ]. Moreover, a recent study showed that APPs often provide direct additional value compared to a physician, as it measured process-related outcomes of APPs in a simulated rapid response team environment and showed that an APP might perform better than a medical resident (MR) [ 17 ].…”