Outcomes of Nurse Practitioner-Delivered Critical Care

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Presentation transcript:

Outcomes of Nurse Practitioner-Delivered Critical Care Janna S. Landsperger, ACNP-BC, Matthew W. Semler, MD, Li Wang, MS, Daniel W. Byrne, MS, Arthur P. Wheeler, MD CHEST Volume 149, Issue 5, Pages 1146-1154 (May 2016) DOI: 10.1016/j.chest.2015.12.015 Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 1 Derivation of the study cohort. All admissions to the ACNP service and resident services were included in analysis. ACNP = acute care nurse practitioners. CHEST 2016 149, 1146-1154DOI: (10.1016/j.chest.2015.12.015) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 2 Survival by admitting service. (A) In a Cox proportional-hazards regression analysis adjusting for age, sex, ventilator use, vasopressor use, and University HealthSystem Consortium expected mortality, there was no difference between the NP and resident services in the primary outcome of 90-day survival. (B) The hazard ratio for death in the first 90 days was similar between services in subgroups defined by admitting diagnosis, number of ICU admissions during the study period, day of the week on which the admission occurred, and time of day of the admission. There was a suggestion of improved survival within the admitting diagnosis of glucose disorders on the NP service and with altered mental status on the resident service. Glucose disorder includes diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, and hypoglycemia; weekday refers to Monday-Friday; daytime refers to 7 am through 7 pm. NP = nurse practitioner. CHEST 2016 149, 1146-1154DOI: (10.1016/j.chest.2015.12.015) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 3 Observed relative to expected mortality by admitting service. For the acute care nurse practitioner (ACNP) service (red) and residents services (blue), the proportion of admissions that died before hospital discharge (mean and 95% CI) is displayed at each rate of expected in-hospital mortality as estimated by the UHC national data. Histograms display the distribution of expected mortality rates for patients admitted to each service. UHC = University HealthSystem Consortium. See Figure 2 legend for expansion of other abbreviation. CHEST 2016 149, 1146-1154DOI: (10.1016/j.chest.2015.12.015) Copyright © 2016 American College of Chest Physicians Terms and Conditions