Mortality Rates Similar on MICUs Staffed by Nurse Practitioners and Physician Residents
A multi-disciplinary group of clinician researchers working in the medical intensive care units (MICU) at Thomas Jefferson University Hospital found no significant difference in mortality of patients on two separate units; one staffed by nurse practitioners, the other by resident physicians. Both groups of patients were under the care of an attending physician. They concluded that both staffing models provide safe, effective care and published their results in Critical Care Medicine.
"Medical Intensive Care Units across the country are looking at alternatives to the physician-based care models due to a nationwide shortage of critical care doctors, particularly in academic medical centers," said David Oxman, MD, senior author and critical care physician. "Our study showed that both resident physicians and nurse practitioners provide safe care with no difference in mortality."
In 2012, Thomas Jefferson University Hospital opened a new, eight-bed MICU staffed by nurse practitioners. This gave researchers a unique opportunity to study the staffing model and compare it to a 17-bed unit in the same hospital but staffed with resident physicians. The team conducted a retrospective chart review of 1,157 patients and looked at a variety of measures. Their main finding showed similar rates of patient mortality for the nurse practitioner-staffed MICU (14.5 percent) and the resident physician-staffed ICU (13.1 percent), both within national estimates of MICU mortality (12-16 percent). In addition, 48-hour readmissions to the MICU were similar among the two groups of patients.
"As healthcare evolves, our staffing models need to keep pace," said Rachel Scherzer, MSN, RN, ACNP-BC and first author. "These data back up what practicing doctors and nurses have known for some time - advanced practice providers can render safe and effective ICU care, and are part of the answer to shortages in the critical care workforce."
The study authors recommend a prospective, randomized study to validate their findings.
Citation: Scherzer, R., et al. A comparison of Usage and Outcomes between Nurse Practitioner and Resident-Staffed Medical ICUs. Critical Care Medicine. September 2016.
The study was supported, in part, by intramural funding from Jefferson College of Nursing.
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