Many medical centers make use of both physicians and nurse practitioners, but few studies have evaluated outcomes of care delivered by acute care nurse practitioners (ACNPs) in ICUs. Hoffman and colleagues examined patient outcomes on a subacute medical ICU, comparing those cared for by a team consisting of an ACNP and attending physician and a team consisting of critical care or pulmonary fellows and an attending physician. Only one team at a time provided care. On each team, the ACNP and the fellows managed care-assessment, diagnosis, order writing, ventilator weaning, and extubation-and the attending physician provided oversight of and consultation to the team and conducted daily rounds.

During the 31-month study period, 526 patients (average age, 63) were admitted, with 250 managed by the ACNP team and 276 by the fellows team. Patients who were weaned from mechanical ventilation (n = 241) were less likely to require reintubation when managed by the ACNP team (2%) than by the fellows team (10%). Other outcomes measured included length of stay and rates of readmission and death; they didn't differ in the two groups. These results indicate that an ACNP- and-physician team can safely manage patients in a subacute ICU setting.

Hoffman LA, et al. Am J Crit Care 2005;14(2):121-30.