Nurse Practitioner/Physician Assistant Staffing and Critical Care Mortality.

Link to article at PubMed

Related Articles

Nurse Practitioner/Physician Assistant Staffing and Critical Care Mortality.

Chest. 2014 Aug 28;

Authors: Costa DK, Wallace DJ, Barnato AE, Kahn JM

Abstract
ABSTRACT: Background:Intensive care units (ICUs) are increasingly staffed with nurse practitioners/ physician assistants (NP/PAs) but it is unclear how they influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for ICU patients. Methods:We used retrospective cohort data from the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system and an ICU-level survey. We included patients (≥ 17 years of age) admitted to one of 29 adult medical and mixed medical-surgical ICUs in 22 U.S. hospitals. Since our survey could not assign NP/PAs to individual patients, the primary exposure was admission to an ICU where NP/PAs participated in patient care. The primary outcome was patient level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NP/PAs on in-hospital mortality, accounting for differences in case-mix, ICU characteristics and clustering of patients within ICUs. We also examined this relationship in subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (>55), ICUs with low intensity physician staffing and with physician trainees. Results:21 (72.4%) ICUs had NP/PAs. Patients in ICUs with NP/PAs had lower mean Acute Physiology Scores (42.4 vs. 46.7 p<0.001), and mechanical ventilation rates (38.8% vs. 44.2%, p<0.001) than ICUs without NP/PAs. Unadjusted and risk-adjusted mortality were similar between groups [adjusted relative risk: 1.10, (95% CI: 0.92, 1.31)]. This result was consistent in all examined subgroups. Conclusions:NP/PAs appear to be a safe adjunct to the ICU team, supporting NP/PA management of the critically ill.
Background: Intensive care units (ICUs) are increasingly staffed with nurse practitioners/ physician assistants (NP/PAs) but it is unclear how they influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for ICU patients.
Methods: We used retrospective cohort data from the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system and an ICU-level survey. We included patients (≥ 17 years of age) admitted to one of 29 adult medical and mixed medical-surgical ICUs in 22 U.S. hospitals. Since our survey could not assign NP/PAs to individual patients, the primary exposure was admission to an ICU where NP/PAs participated in patient care. The primary outcome was patient level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NP/PAs on in-hospital mortality, accounting for differences in case-mix, ICU characteristics and clustering of patients within ICUs. We also examined this relationship in subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (>55), ICUs with low intensity physician staffing and with physician trainees.
Results: 21 (72.4%) ICUs had NP/PAs. Patients in ICUs with NP/PAs had lower mean Acute Physiology Scores (42.4 vs. 46.7 p<0.001), and mechanical ventilation rates (38.8% vs. 44.2%, p<0.001) than ICUs without NP/PAs. Unadjusted and risk-adjusted mortality were similar between groups [adjusted relative risk: 1.10, (95% CI: 0.92, 1.31)]. This result was consistent in all examined subgroups.
Conclusions: NP/PAs appear to be a safe adjunct to the ICU team, supporting NP/PA management of the critically ill.

PMID: 25167081 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *