title: A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs.
abstract: OBJECTIVE
  To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU.
  
  
  METHODS
  Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013.
  
  
  METHODS
  Large urban academic university hospital.
  
  
  METHODS
  One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19.1%) and 936 resident-staffed medical ICU admissions (80.9%).
  
  
  METHODS
  None.
  
  
  RESULTS
  Data obtained included age, gender, race, medical ICU admitting diagnosis, location at time of ICU transfer, code status at ICU admission, and severity of illness using both Acute Physiology and Chronic Health Evaluation II scores and a model for relative expected mortality. Primary outcomes compared included ICU mortality, in-hospital mortality, medical ICU length of stay, and post-ICU discharge hospital length of stay. Patients admitted to the nurse practitioner-staffed medical ICU were older (63 ± 16.5 vs 59.2 ± 16.9 yr for resident-staffed medical ICU; p = 0.019), more likely to be transferred from an inpatient unit (52.0% vs 40.0% for the resident-staffed medical ICU; p = 0.002), and had a higher severity of illness by relative expected mortality (21.3 % vs 17.2 % for the resident-staffed medical ICU; p = 0.001). There were no differences among primary outcomes except for medical ICU length of stay (nurse practitioner-resident-staffed 7.9 ± 7.5 d vs resident-staffed medical ICU 5.6 ± 6.5 d; p = 0.0001). Post-hospital discharge to nonhome location was also significantly higher in the nurse practitioner-ICU (31.7% in nurse practitioner-staffed medical ICU vs 23.9% in resident-staffed medical ICU; p = 0.24).
  
  
  CONCLUSIONS
  We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.
authors.affiliation: 1Thomas Jefferson University, Jefferson College of Nursing, Philadelphia, PA. 2Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scherzer
authors.forename: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Swan
authors.forename: Mani S
authors.initials: MS
authors.lastname: Kavuru
authors.forename: David A
authors.initials: DA
authors.lastname: Oxman
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000078329:Workforce