Outcomes of tube thoracostomies performed by advanced practice providers vs trauma surgeons.
BACKGROUND
The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians' capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians.


OBJECTIVE
To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure.


METHODS
Retrospective blinded reviews of patients' charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers.


RESULTS
Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good.


CONCLUSIONS
Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.
Bevis
Laura C
LC
Wesley Medical Center, Wichita, Kansas, USA.
Berg-Copas
Gina M
GM
Thomas
Bruce W
BW
Vasquez
Donald G
DG
Wetta-Hall
Ruth
R
Brake
David
D
Lucas
Eddy
E
Toumeh
Khaled
K
Harrison
Paul
P
D000328:Adult; D000488:Allied Health Personnel; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D015588:Observer Variation; D010820:Physicians; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D013907:Thoracostomy / Q000379:methods*; D016896:Treatment Outcome