The impact of the addition of nurse practitioners to surgical intensive care units: A retrospective cohort study |
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| Affiliation: | 1. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, North Dist., Tainan City, 704, Taiwan;2. Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan, No. 66, Sec. 2, Changhe Road., Annan Dist., Tainan City, 709, Taiwan;3. Centre for Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, QLD, 4222, Australia;4. Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, No. 89, Wenhua 1st St., Rende Dist., Tainan City 717, Taiwan;1. St Vincent''s Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia;2. Garvin Institute for Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia;3. University of New South Wales, High St, Kensington, NSW, 2052, Australia;1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia;2. Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia;3. Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia;4. Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia;5. Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia |
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| Abstract: | BackgroundDemand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated.ObjectivesTo compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team.MethodsWe conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation.ResultsA total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions.ConclusionIncorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team. |
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| Keywords: | Critical care Intensive care units Mortality Nurse practitioners Surgery |
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