RESUMO
OBJECTIVE: To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. DESIGN: Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013. SETTING: Large urban academic university hospital. SUBJECTS: 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%). INTERVENTIONS: None. MEASUREMENTS AND MAIN 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.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Recursos HumanosRESUMO
A diminutive and inaccurate title for advanced practice nurses.
Assuntos
Competência Clínica/normas , Descrição de Cargo , Profissionais de Enfermagem/normas , Papel do Profissional de Enfermagem , Humanos , Estados UnidosAssuntos
Relações Interprofissionais , Pesquisa em Enfermagem/educação , Publicações Periódicas como Assunto , Estudantes de Enfermagem/psicologia , Ensino/métodos , Enfermagem Baseada em Evidências/organização & administração , Humanos , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em EnfermagemRESUMO
Ventilator-associated pneumonia is a common nosocomial infection that results in both negative patient outcomes and increased health care costs. Recently, many efforts have been targeted at ventilator-associated pneumonia prevention, including the practice of subglottic secretion aspiration. Six randomized control studies examining the effectiveness of subglottic secretion aspiration in the prevention of ventilator-associated pneumonia were reviewed for this article. Results consistently show that subglottic secretion aspiration significantly reduces the incidence of ventilator-associated pneumonia in a variety of patient populations. Despite these findings, this practice is limited in clinical settings. This clinical practice should be implemented in individuals requiring mechanical ventilation to reduce the incidence of ventilator-associated pneumonia.