PURPOSE:There is a perception among intensivists that the variable nurse practitioner (NP) student training in invasive procedures is a barrier to hiring NPs as physician alternatives in the ICU. We have developed an adult ICU NP training program that includes credentialing in commonly performed invasive procedures in the ICU.
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). Procedures considered included arterial and central venous catheterization, chest tube insertion and intubation. Chest tubes are performed by fellows and attendings only.
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. There were no significant differences in number of procedures performed per patient. No difference was noted in the complication rate.
CONCLUSION:In two similar populations of ICU patients, invasive procedures were performed at similar frequencies with similar complication rates regardless of HS or NP admitting service.
CLINICAL IMPLICATIONS:Training NPs to do invasive procedures is feasible and safe in an adult ICU. There seems to be no significant impact on procedure frequency or complication rate.
DISCLOSURE:Noelia Maamouri, No Financial Disclosure Information; No Product/Research Disclosure Information