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Correspondence |

Nurse Practitioners Cannot Handle Complex ICU Patients FREE TO VIEW

Saadah Alrajab, MD, MPH; Firas Abubaker, MD
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Editor’s Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aPresbyterian Intercommunity Hospital Ringgold, Whittier, CA

bSt. Bernardine Medical Center, Yorba Linda, CA

CORRESPONDENCE TO: Saadah Alrajab, MD, MPH, 12462 Putnam St, Ste 208, Whittier, CA 90602


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


Chest. 2016;150(3):746. doi:10.1016/j.chest.2016.05.037
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We read with great interest “Outcomes of Nurse Practitioner-Delivered Critical Care: A Prospective Cohort Study” recently published in CHEST (May 2016).

The initial impression of the reader is in favor of acute care nurse practitioners (ACNPs). It is important to point out that this study can never be generalized to community ICUs for the following reasons:

  • 1.

    Each patient in the study was covered by an intern, a resident, a fellow, and an attending physician or by an ACNP, a fellow, and an attending physician. In real community settings it would be either a trained critical care physician alone or a nurse practitioner (NP) who is supposedly supervised by a physician, most likely a busy physician.

  • 2.

    In academic settings, each patient is followed by different providers, which provides a higher chance of picking up issues overlooked by others and also prevents the chance of unnecessary procedures being performed by less-experienced physicians in training.

  • 3.

    More patients cared for by the non-ACNPs were receiving pressors and mechanical ventilation, raising concerns about giving NPs less-complicated critical care cases and skewing data toward the null.

It would be helpful to compare care provided by physicians or physicians plus ACNPs in closed ICUs in the community. Such a study must ensure that the level of acute conditions are equal in both arms and must be able to assess the level of intervention and supervision provided by the physician in the ACNP arm, an issue that was not addressed in this study.

We believe that in a busy community setting, having an NP run ICU care might be helpful only in selected patients with conditions that are not acute and in routine cases, but it would definitely be dangerous to assume from the current study that complex cases can be handled safely by ACNPs even with the presumed physician supervision.

References

Landsperger J.S. .Semler M.W. .Wang L. .Byrne D.W. .Wheeler A.P. . Outcomes of nurse practitioner-delivered critical care: a prospective cohort study. Chest. 2016;149:1146-1154 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Landsperger J.S. .Semler M.W. .Wang L. .Byrne D.W. .Wheeler A.P. . Outcomes of nurse practitioner-delivered critical care: a prospective cohort study. Chest. 2016;149:1146-1154 [PubMed]journal. [CrossRef] [PubMed]
 
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