Nurse Practitioner/Physician Assistant Staffing and Critical Care Mortality

Costa, Deena Kelly; Wallace, David J.; Barnato, Amber E.; Kahn, Jeremy M.

doi:10.1378/chest.14-0566

Cited by 98 publications

(35 citation statements)

References 37 publications

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“…As in our study, there was no difference in clinical competencies (ie, history taking, physical exam, communication, and report) between PAs and residents in anaesthesiology and surgery . Furthermore, studies in the ICU reported the same quality of care by teams with PAs in comparison with teams without PAs . In these studies, quality of care was measured by clinical indicators, for instance, mortality, fewer, pain or infections.…”

Section: Discussionsupporting

confidence: 57%

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients

Vught

Brink

Hilkens

et al. 2018

Evaluation Clinical Practice

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Rationale, aims, and objectivesSince adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU.MethodPhysician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases. The level of clinical skills of PAs and MRs was videotaped and scored with predefined checklists by 2 independent intensivists per scenario. Percentage of the total score was calculated, and means were compared by Student t test.ResultsA total of 11 PAs and 10 MRs participated in the study. Physician assistants and MRs scored equal (PA 66% ± 13% vs MR 68% ± 9%, P = .86) on their clinical performance in the simulated ICU setting.ConclusionThis study showed equal performance of PAs and MRs on clinical skills in the simulated ICU setting.

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Section: Discussionsupporting

confidence: 57%

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients

Vught

Brink

Hilkens

et al. 2018

Evaluation Clinical Practice

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“…In some cases, advanced practice providers have been added to traditional physician staffing models, and in other cases, they have assumed duties traditionally performed by physicians (6)(7)(8)(9)(10)(11). Although NPs were first introduced to the healthcare workforce in the 1960s (12,13), the use of NPs as providers in the ICU is a relatively recent development that has expanded rapidly (14).…”

mentioning

confidence: 99%

“…Yet despite the proliferation of NPs in the critical care workforce, studies examining outcomes in ICUs staffed by advanced practice providers with traditional models are limited. Recently, Costa et al (14) published a multicenter study comparing outcomes in ICUs in which advanced practice providers were part of the ICU team versus ICUs without advanced practice provider participation. Published data on outcomes in ICUs in which NPs completely replaced a part of the physician team (i.e., resident physicians) are limited to one study (7).…”

mentioning

confidence: 99%

A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs

Scherzer

Dennis

Swan

et al. 2017

Critical Care Medicine

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“…Instead, efforts could be directed at expanding other organizational factors, such the number of bachelors prepared nurses and improved nursing work environments, which are associated with lower mortality (19). Efforts might also be directed at expanding care models in which intensivists don’t directly manage every patients but instead simply oversee the ICU, with direct day-to-day care provided by hospitalists or nurse practitioners/physician assistants (20, 21). These models may be more feasible than bringing high-intensity daytime staffing to ICU, and, as evidenced by this study, may bring similar results.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Daytime Intensivist Physician Staffing and Mortality in the Context of Other ICU Organizational Practices

Costa

Wallace

Kahn

2015

Critical Care Medicine

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Objective Daytime intensivist physician staffing is associated with improved outcomes in the intensive care unit (ICU). However, it is unclear whether this association persists in the era of interprofessional, protocol-directed critical care. We sought to reexamine the association between daytime intensivist physician staffing and ICU mortality and determine if interprofessional rounding and protocols for mechanical ventilation in part mediate this relationship. Design Retrospective cohort study of ICUs in the Acute Physiology and Chronic Health Evaluation clinical information system from 2009–2010. Setting 49 ICUs in 25 US hospitals. Patients Adults (17 years and older) admitted to a study ICU. Measurements and Main Results We defined high-intensity daytime intensivist staffing as either a mandatory consult or closed ICU model; interprofessional rounds as rounds that included a respiratory therapist, pharmacist, physician and nurse; and protocol use as having protocols for liberation from mechanical ventilation and lung protective mechanical ventilation. Using multivariable logistic regression, we estimated the independent effect of daytime intensivist physician staffing on in-hospital mortality controlling for interprofessional rounds and protocols for mechanical ventilation, as well as other patient and hospital characteristics. 27 (55%) of ICUs reported high-intensity daytime physician staffing, 42 (85%) of ICUs reported daily interprofessional rounds and 31 (63%) reported having protocols for mechanical ventilation. There was no association between daytime intensivist physician staffing and in-hospital mortality [adjusted OR 0.86, 95% CI (0.65–1.14)]. After adjusting for interprofessional rounds and protocols for mechanical ventilation the effect of daytime intensivist physician staffing remained non-significant [adjusted OR 0.90, 95% (0.70, 1.17)]. Conclusion High-intensity daytime physician staffing in the ICU was not significantly associated with lower mortality in a modern cohort. This association was not affected by interprofessional rounds or protocols for mechanical ventilation.

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Nurse Practitioner/Physician Assistant Staffing and Critical Care Mortality

Abstract: NPs/PAs appear to be a safe adjunct to the ICU team. The findings support NP/PA management of critically ill patients.

Cited by 98 publications

References 37 publications

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients

Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients

A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs

The Association Between Daytime Intensivist Physician Staffing and Mortality in the Context of Other ICU Organizational Practices

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