title: A systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.
abstract: BACKGROUND
  Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges?
  
  
  METHODS
  We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns.
  
  
  RESULTS
  Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix.
  
  
  CONCLUSIONS
  Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.
authors: From the *Division of Plastic Surgery, and †NC Jaycee Burn Center, University of North Carolina Health Care System, Chapel Hill, NC.
authors: Renee E
authors: RE
authors: Edkins
authors: Bruce A
authors: BA
authors: Cairns
authors: C Scott
authors: CS
authors: Hultman
mesh_terms: D057179:Advanced Practice Nursing / Q000191:economics / Q000458:organization & administration*; D002056:Burns / Q000191:economics / Q000628:therapy*; D017046:Cost Savings; D003422:Critical Care / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D007396:Internship and Residency / Q000191:economics; D007902:Length of Stay / Q000191:economics; D024802:Nurse's Role; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D063868:Patient Outcome Assessment