The Use of Nonphysician Providers in Adult Intensive Care Units

Abstract

In the United States there are not currently enough critical care-trained practitioners to provide care to all critically ill patients. With calls for "high-intensity" staffing and 24-hour coverage of our intensive care units, the board-certified intensivists we do have are being stretched ever more thin. Nonphysician providers (physician assistants and nurse practitioners) are being used with increasing frequency in critical care settings to provide care to critically ill patients. In this review, we explore the impact of introducing nonphysician providers into the adult intensive care unit.

Physician extenders on surgical services: a systematic review

“…2,3,14,15,21,23,27,30,31 It is important that we critically examine the effect that these changes have on the hospital work environment, and most importantly on patient care, before advocating widespread adoption.…”

“…One of the most well-researched solutions is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. These NPs and PAs, often called "midlevel practitioners," "nonphysician providers," or "physician extenders" (PEs), have been shown to be a safe and effective addition to health care teams 1,2 To avoid the negative connotation associated with the term "midlevel practi tioners," we prefer to use the term PEs to refer to NPs and PAs.…”

Provider to Patient Ratios for Nurse Practitioners and Physician Assistants in Critical Care Units

“…Many institutions are implementing alternative staffing models that include use of NPs and PAs to meet the needs of acute and critically ill patients, and recent reports highlight the benefit to providing quality of care in the ICU. [23][24][25][26][27][28][29] Additional research is needed to determine optimal NP or PA provider to patient ratios based on factors such as changes in patient acuity levels, need for invasive and therapeutic procedures, daily admission and discharge numbers, educational needs of patients and patients' families, and time spent by advanced practice providers in nonclinical duties. This research is especially important, because the roles of NPs and PAs are extending beyond general patient care management to include oversight of evidence-based practice initiatives and clinical staff education.…”

Critical Care Medicine Advanced Practice Provider Model at a Comprehensive Cancer Center: Successes and Challenges

“…APPs also improve continuity of care and are more likely than the residents to interact with both the multidisciplinary health care team and family members of ICU patients. [1][2][3] Similar to the APP-RN dynamic, the relationship between the CCM APPs and fellows can be www.ajcconline.org Table 2 Educational curriculum for nurse practitioners and physician assistants in the intensive care unit …”

“…[1][2][3][4][5][6] Recent survey data suggest that NPs and PAs provide care in >50% and ~25%, respectively, of adult ICUs in academic medical centers in the United States. 7 APPs are typically utilized in 2 distinct paradigms in the ICU setting.…”