title: Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit.
abstract: BACKGROUND
  Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.
  
  
  OBJECTIVE
  To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.
  
  
  METHODS
  During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.
  
  
  RESULTS
  Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).
  
  
  CONCLUSIONS
  In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.
authors.affiliation: Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hoffman
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Tasota
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Zullo
authors.forename: Carmella
authors.initials: C
authors.lastname: Scharfenberg
authors.forename: Michael P
authors.initials: MP
authors.lastname: Donahoe
mesh_terms: D000368:Aged; D004496:Education, Continuing; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010820:Physicians; D012121:Respiration, Artificial; D014481:United States