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Original Research: CRITICAL CARE |

Impact of Nonphysician Staffing on Outcomes in a Medical ICU

Hayley B. Gershengorn, MD; Hannah Wunsch, MD; Romina Wahab, MD; David Leaf, MD; Daniel Brodie, MD, FCCP; Guohua Li, MD, DrPH; Phillip Factor, DO, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs Gershengorn and Factor), Beth Israel Medical Center; and the Department of Anesthesia (Drs Wunsch and Li), the Department of Medicine (Drs Wahab and Leaf), and the Division of Pulmonary, Allergy, and Critical Care (Dr Brodie), New York Presbyterian Hospital-Columbia, New York, NY.

Correspondence to: Hayley B. Gershengorn, MD, Section of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, 1st Ave at 16th St, New York, NY 10003; e-mail: hgershengorn@chpnet.org


This work has been presented in poster form (Gershengorn HB, Wunsch H, Wahab R, et al. Am J Respir Crit Care Med. 2010:A2409).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1347-1353. doi:10.1378/chest.10-2648
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Background:  As the number of ICU beds and demand for intensivists increase, alternative solutions are needed to provide coverage for critically ill patients. The impact of different staffing models on the outcomes of patients in the medical ICU (MICU) remains unknown. In our study, we compare outcomes of nonphysician provider-based teams to those of medical house staff-based teams in the MICU.

Methods:  We conducted a retrospective review of 590 daytime (7:00 am-7:00 pm) admissions to two MICUs at one hospital. In one MICU staffed by nurse practitioners and physician assistants (MICU-NP/PA) there were nonphysicians (nurse practitioners and physicians assistants) during the day (7:00 am-7:00 pm) with attending physician coverage overnight. In the other MICU, there were medicine residents (MICU-RES) (24 h/d). The outcomes investigated were hospital mortality, length of stay (LOS) (ICU, hospital), and posthospital discharge destination.

Results:  Three hundred two patients were admitted to the MICU-NP/PA and 288 to the MICU-RES. Mortality probability model III (MPM0-III) predicted mortality was similar (P = .14). There was no significant difference in hospital mortality (32.1% for MICU-NP/PA vs 32.3% for MICU-RES, P = .96), MICU LOS (4.22 ± 2.51 days for MICU-NP/PA vs 4.44 ± 3.10 days for MICU-RES, P = .59), or hospital LOS (14.01 ± 2.92 days for MICU-NP/PA vs 13.74 ± 2.94 days for MICU-RES, P = .86). Discharge to a skilled care facility (vs home) was similar (37.1% for MICU-NP/PA vs 32.5% for MICU-RES, P = .34). After multivariate adjustment, MICU staffing type was not associated with hospital mortality (P = .26), MICU LOS (P = .29), hospital LOS (P = .19), or posthospital discharge destination (P = .90).

Conclusions:  Staffing models including daytime use of nonphysician providers appear to be a safe and effective alternative to the traditional house staff-based team in a high-acuity, adult ICU.

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