PURPOSE:Although Nurse practitioners (NPs) have long been active in caring for critically ill neonates, they have not similarly been integrated into the adult ICU. There is little data comparing outcomes of critically ill adults cared for by NPs and house staff (HS).
METHODS:Data were collected retrospectively from all patients admitted to a closed 16 bed medical-surgical ICU at a tertiary cancer center during a 7-month period (June 1, 2007- December 31, 2007). Admissions are to one of two separate ICU teams (HS or NP) based on team census. Maximum HS census is 10 patients, maximum NP census is 6. We compared the following variables by team assignment (HS or NP): demographics, Mortality Probability Model II (MPM II) score, use of mechanical ventilation (MV), vasopressors (VP) or continuous renal replacement therapy (CRRT) and ICU and hospital length of stay (LOS) and mortality. Statistical analysis was performed using Chi-square analysis and Fisher's exact test.
RESULTS:There were 367 admissions to the ICU, 214 (58%) of whom were admitted to the HS service. There were no significant differences in age, gender, MPM II score, and use of MV, VP or CRRT. Sepsis was a more frequent diagnosis for HS than NP. There were no significant differences ICU, Post-ICU or Hospital LOS or mortality.
CONCLUSION:The acuity and outcome of patients admitted to the HS and NP ICU services are similar. No significant differences exist between HS and NP admission diagnoses with the exception of Sepsis.
CLINICAL IMPLICATIONS:A wide variety of patients with a relatively high acuity can be cared for by an NP team in the adult ICU without significant differences in outcome in comparison to the traditional HS model. Perhaps subconscious triage biases exist which explain the difference in Sepsis admissions between the two groups.
DISCLOSURE:Saraswathi Muppana, No Financial Disclosure Information; No Product/Research Disclosure Information