Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, North Dist., Tainan City, 704, Taiwan.
Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan, No. 66, Sec. 2, Changhe Road., Annan Dist., Tainan City, 709, Taiwan; Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, No. 89, Wenhua 1st St., Rende Dist., Tainan City 717, Taiwan.
Aust Crit Care. 2019 May;32(3):244-248. doi: 10.1016/j.aucc.2018.05.004. Epub 2018 Jul 10.
Demand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated.
To compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team.
We conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation.
A total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263-0.865; p = 0.015) among scheduled admissions.
Incorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.
对外科重症监护的需求正在增加，但住院医师的工作时间限制已经影响了许多医院。最近，护士从业者（NPs）作为重症监护病房（ICU）的提供者的使用迅速扩大，尽管尚未评估对护理质量的影响。
比较在 ICU 团队中增加 NPs 前后外科危重病患者的结局。
我们在台湾的外科 ICU 进行了回顾性队列研究。我们比较了在 ICU 团队中增加 NPs 的前 2 年和后 2 年期间入住 ICU 的患者的结局。排除在 1 年过渡阶段入院的患者进行比较。主要终点是 ICU 死亡率。次要终点包括 ICU 住院时间和计划外拔管的发生率。
共有 8747 名患者纳入研究。对于所有合格的入院患者，两组之间的主要和次要结局均无显着差异。对于计划的 ICU 入院，在增加 NPs 后 ICU 死亡率显着降低（2.2%之前 vs. 1.1%之后添加 NPs，p=0.014）。对于非计划的 ICU 入院，两组之间的 ICU 死亡率无显着差异。在多变量分析中，与传统的以住院医师为基础的团队相比，在计划的 ICU 入院中，在添加 NPs 后入院与 ICU 死亡率显着降低相关（比值比=0.481；95%置信区间=0.263-0.865；p=0.015）。
与传统的以住院医师为基础的团队相比，在 ICU 团队中纳入 NPs 与计划的外科 ICU 入院患者的结局改善相关。
