Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit

• Published in: American journal of critical care Vol. 14; no. 2; pp. 121 - 130
• Main Authors: Hoffman, Leslie A, Tasota, Frederick J, Zullo, Thomas G, Scharfenberg, Carmella, Donahoe, Michael P
• Format: Journal Article
• Language: English
• Published: United States American Association of Critical - Care Nurses 01.03.2005
• Subjects: Aged; Education, Continuing; Female; Humans; Intensive Care Units - organization & administration; Length of Stay; Male; Medical Staff, Hospital; Middle Aged; Nurse Practitioners; Nursing; Outcome Assessment (Health Care); Patient Care Team; Physicians; Respiration, Artificial; United States; United States
• ISSN: 1062-3264; 1937-710X
• DOI: 10.4037/ajcc2005.14.2.121

Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff. To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows. During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes. Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02). In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.