Department of Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu 300, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; College of Medicine, National Taiwan University, Taipei 100, Taiwan.
Department of Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu 300, Taiwan.
Aust Crit Care. 2022 Nov;35(6):630-635. doi: 10.1016/j.aucc.2021.10.004. Epub 2021 Nov 29.
Rapid developments in medical care-such as monitoring devices, medications, and working hours restrictions for intensive care personnel-have dramatically increased the demand for intensive care physicians. Therefore, nurse practitioner (NP)-staffed care is becoming increasingly important. This study was aimed to compare the outcomes of daytime NP-staffed and daytime resident-staffed nonsurgical intensive care units (ICU).
We retrospectively assessed patients admitted to a nonsurgical ICU from March 2017 to December 2017. We collected basic patient data, including age, sex, admission diagnosis, transferring unit, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Primary endpoints were ICU mortality, hospital mortality, and 30-day mortality. Secondary endpoints were 48-h readmission, discharge to nonhome locations, and lengths of ICU and hospital stay.
A total of 838 subjects were analysed: 334 subjects in the NP-staffed group and 504 in the resident-staffed group. The NP-staffed group was more likely to come from inpatient units (38.3% vs 16.5% for resident-staffed group; p < 0.001) and had lower disease severity (APACHE II score, 13.9 ± 8.4 vs 15.1 ± 8.2 for resident-staffed group; p = 0.047). After adjusting for age, sex, location before ICU admission, APACHE II score, and significantly different basic characteristics, there were no differences in ICU mortality, hospital mortality, or 30-day mortality between the two groups. Secondary analysis showed the NP-staffed group had a lower discharge rate to nonhome locations (2.1% vs 6.3%; p = 0.023) and shorter hospital stay (12.1 ± 14.1 vs 14.2 ± 14.3 days; p = 0.015).
We observed no difference in mortality between daytime NP-staffed and resident-staffed nonsurgical ICUs. Daytime NP-staffed care is an effective, safe, feasible method for staffing nonsurgical ICUs.
医疗保健的快速发展，如监测设备、药物和重症监护人员工作时间限制，极大地增加了对重症监护医师的需求。因此，护士执业医师（NP）人员配备的护理变得越来越重要。本研究旨在比较日间 NP 人员配备和日间住院医师人员配备的非外科重症监护病房（ICU）的结果。
我们回顾性评估了 2017 年 3 月至 2017 年 12 月期间入住非外科 ICU 的患者。我们收集了基本患者数据，包括年龄、性别、入院诊断、转科和急性生理学和慢性健康评估 II（APACHE II）评分。主要终点是 ICU 死亡率、医院死亡率和 30 天死亡率。次要终点是 48 小时再入院、出院至非家庭地点、以及 ICU 和住院时间。
共分析了 838 例患者：334 例 NP 人员配备组和 504 例住院医师人员配备组。NP 人员配备组更有可能来自住院病房（38.3% vs 住院医师人员配备组的 16.5%；p<0.001），疾病严重程度较低（APACHE II 评分，13.9±8.4 vs 住院医师人员配备组的 15.1±8.2；p=0.047）。调整年龄、性别、入 ICU 前位置、APACHE II 评分和显著不同的基本特征后，两组之间 ICU 死亡率、医院死亡率或 30 天死亡率无差异。进一步分析显示，NP 人员配备组的非家庭出院率较低（2.1% vs 6.3%；p=0.023），住院时间较短（12.1±14.1 天 vs 14.2±14.3 天；p=0.015）。
我们观察到日间 NP 人员配备和住院医师人员配备的非外科 ICU 之间的死亡率无差异。日间 NP 人员配备护理是一种有效、安全、可行的非外科 ICU 人员配备方法。
