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Original Research: Critical Care |

Outcomes of Nurse Practitioner-Delivered Critical Care: A Prospective Cohort Study

Janna S. Landsperger, ACNP-BC; Matthew W. Semler, MD; Li Wang, MS; Daniel W. Byrne, MS; Arthur P. Wheeler, MD
Author and Funding Information

FUNDING/SUPPORT: Investigators contributing to this study were supported by a National Heart, Lung, and Blood Institute T32 award [grant HL087738 09]. Data collection used the Research Electronic Data Capture (REDCap) tool developed and maintained with Vanderbilt Institute for Clinical and Translational Research [grant UL1 TR000445 from the National Center for Advancing Translational Science/National Institutes of Health].

CORRESPONDENCE TO: Janna S. Landsperger, ACNP-BC, Medical Center North, Vanderbilt University School of Medicine, Suite T-1218, 1161 21st Ave S, Nashville, TN 37232


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):1146-1154. doi:10.1016/j.chest.2015.12.015
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Background  Acute care nurse practitioners (ACNPs) are increasingly being employed in ICUs to offset physician shortages, but no data exist about outcomes of critically ill patients continuously cared for by ACNPs.

Methods  Prospective cohort study of all admissions to an adult medical ICU in an academic, tertiary-care center between January 1, 2011, and December 31, 2013. The primary end point of 90-day survival was compared between patients cared for by ACNP and resident teams using Cox proportional hazards regression. Secondary end points included ICU and hospital mortality and ICU and hospital length of stay.

Results  Among 9,066 admissions, there was no difference in 90-day survival for patients cared for by ACNP or resident teams (adjusted hazard ratio [HR], 0.94; 95% CI, 0.85-1.04; P = .21). Although patients cared for by ACNPs had lower ICU mortality (6.3%) than resident team patients (11.6%; adjusted OR, 0.77; 95% CI, 0.63-0.94; P = .01), hospital mortality was not different (10.0% vs 15.9%; adjusted OR, 0.87; 95% CI, 0.73-1.03; P = .11). ICU length of stay was similar between the ACNP and resident teams (3.4 ± 3.5 days vs 3.7 ± 3.9 days [adjusted OR, 1.01; 95% CI, 0.93-1.1; P = .81]), but hospital length of stay was shorter for patients cared for by ACNPs (7.9 ± 11.2 days) than for resident patients (9.1 ± 11.2 days) (adjusted OR, 0.87; 95% CI, 0.80-0.95; P = .001).

Conclusion  Outcomes are comparable for critically ill patients cared for by ACNP and resident teams.

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