title: Outcomes of Nurse Practitioner-Delivered Critical Care: A Prospective Cohort Study.
abstract: BACKGROUND
  Acute care nurse practitioners (ACNPs) are increasingly being employed in ICUs to offset physician shortages, but no data exist about outcomes of critically ill patients continuously cared for by ACNPs.
  
  
  METHODS
  Prospective cohort study of all admissions to an adult medical ICU in an academic, tertiary-care center between January 1, 2011, and December 31, 2013. The primary end point of 90-day survival was compared between patients cared for by ACNP and resident teams using Cox proportional hazards regression. Secondary end points included ICU and hospital mortality and ICU and hospital length of stay.
  
  
  RESULTS
  Among 9,066 admissions, there was no difference in 90-day survival for patients cared for by ACNP or resident teams (adjusted hazard ratio [HR], 0.94; 95% CI, 0.85-1.04; P = .21). Although patients cared for by ACNPs had lower ICU mortality (6.3%) than resident team patients (11.6%; adjusted OR, 0.77; 95% CI, 0.63-0.94; P = .01), hospital mortality was not different (10.0% vs 15.9%; adjusted OR, 0.87; 95% CI, 0.73-1.03; P = .11). ICU length of stay was similar between the ACNP and resident teams (3.4 ± 3.5 days vs 3.7 ± 3.9 days [adjusted OR, 1.01; 95% CI, 0.93-1.1; P = .81]), but hospital length of stay was shorter for patients cared for by ACNPs (7.9 ± 11.2 days) than for resident patients (9.1 ± 11.2 days) (adjusted OR, 0.87; 95% CI, 0.80-0.95; P = .001).
  
  
  CONCLUSIONS
  Outcomes are comparable for critically ill patients cared for by ACNP and resident teams.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: janna.landsperger@vanderbilt.edu.
authors.forename: Janna S
authors.initials: JS
authors.lastname: Landsperger
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Semler
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Byrne
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Wheeler
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D029681:Arabidopsis Proteins; D015331:Cohort Studies; D003422:Critical Care; D004268:DNA-Binding Proteins; D003695:Delivery of Health Care; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D062606:Tertiary Care Centers; D043382:DNA-Formamidopyrimidine Glycosylase
chemical_list: D029681:Arabidopsis Proteins; D004268:DNA-Binding Proteins; C468606:MMH-1 protein, Arabidopsis; D043382:DNA-Formamidopyrimidine Glycosylase
keywords: acute care nurse practitioner; critical care; critical care manpower standards; intensive care units; nurse practitioner; outcome assessment (health care); patient care team; physician assistant; quality of health care; retrospective studies
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