This article is a collaboration between 鶹ý and:
PHOENIX -- Nurse practitioner and physician assistant (NP/PA) care in the ICU could have a mortality benefit compared with care teams solely comprising resident physicians, a study showed.
Survival among patients in an ICU cared for by PA and acute care NP was 92.2% compared with 88.6% among those cared for in an adjacent ICU by a team of residents (P=0.047), with all other staffing and resources equal, Joe Keller, PA-c, of the Cleveland Clinic, and colleagues found.
The overall survival rates to hospital discharge were 85.6% and 80.8%, respectively (P=0.039), the researchers reported here at the Society of Critical Care Medicine meeting.
Other outcomes, including length of stay and hospital-acquired infection and readmission rates, were comparable between groups.
"Our findings suggest the partnership of PAs and acute care NPs with pulmonary and critical care physicians and fellows can improve outcomes in the medical ICU and help alleviate the projected shortage of bedside intensivists," Keller told attendees at the oral abstract session.
While the study couldn't attribute causality to the difference, Keller suggested that NPs and PAs could hold an advantage for patient care because of their longer experience in the ICU than residents, resulting perhaps in better patient hand-offs and communication.
In the medical ICUs studied, the NPs/PAs averaged 1.8 years of ICU experience whereas medical residents spend a minority of their time in the ICU, Keller pointed out.
"A nurse practitioner has done something 500 times versus a resident who is training and learning how to do something, who would you think is more experienced?" noted session moderator , of the University of California Davis.
The findings certainly don’t suggest replacing residents with other provider types, but limits on resident’s duty hours have forced that to some extent, he told 鶹ý.
"Nurse practitioners are filling in for some of the healthcare needs, and they're a continuous presence in the ICU," he said. "They work hand in hand."
Prior studies of NP/PA care haven't turned up significant differences in mortality, but Keller noted that this study had stronger methods in isolating staffing as the sole variable.
The study included 1,054 patients -- matched for acute physiology score, APACHE III score, and source of ICU admission -- admitted to the two 10- and 11-bed study ICUs during the study period from July 2013 to April 2014.
Patients were allocated to those ICUs based only on bed availability. Both units drew from the same pool of attendings, fellows, pharmacists, nurses, respiratory therapists, procedure team, and admitting night residents.
However, Keller acknowledged that the retrospective, nonrandomized, single-center observational design as well as small sample size and short duration were limitations.
Disclosures
Keller disclosed no relevant relationships with industry.
Primary Source
Society of Critical Care Medicine
Source Reference: Keller J, et al "ICU outcomes of physician assistants and acute care nurse practioners compared to resident teams" SCCM 2015; Abstract 49.