title: A high-volume trauma intensive care unit can be successfully staffed by advanced practitioners at night.
abstract: It remains unknown whether critically ill trauma patients can be successfully managed by advanced practitioners (APs). The purpose of this study was to examine the impact of night coverage by APs in a high-volume trauma intensive care unit (ICU) on patient outcomes and care processes.
  
  
  
  During the study period, our ICU was staffed by APs during the night shift (7 pm-7 am) from Sunday to Wednesday and by resident physicians (RPs) from Thursday to Saturday. On-call trauma fellows and attending surgeons in house supervised both APs and RPs. Patient outcomes and care processes by APs was compared with those admitted by RPs.
  
  
  
  A total of 289 patients were identified between July 2013 and February 2014. Median lactate clearance rate within 24 hours of admission was similar between study groups (10.0% vs 9.1%; P = .39). Advanced practitioners and RPs transfused patients requiring massive transfusion with a similar blood product ratio (packed red blood cell:fresh frozen plasma) (2.1:1 vs 1.7:1; P = .32). In a multiple logistic regression analysis, AP coverage was not associated with any clinical outcome differences.
  
  
  
  Our data suggest that, with adequate supervision, a high-volume trauma ICU can be safely staffed by APs overnight.
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA. Electronic address: kazuhide.matsushima@med.usc.edu.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Esparza
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Tim
authors.initials: T
authors.lastname: Lee
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Strumwasser
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Magee
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grabo
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Howard
authors.initials: H
authors.lastname: Belzberg
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D039602:After-Hours Care; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009551:Night Care; D009722:Nurse Practitioners; D010561:Personnel Staffing and Scheduling; D010823:Physician Assistants; D010949:Plasma; D012189:Retrospective Studies; D000078329:Workforce; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Advanced practitioner; Critical care; Intensive care unit; Trauma