Kreeftenberg Herman G, de Bie Ashley J R, Aarts Jeroen T, Bindels Alexander J G H, van der Meer Nardo J M, van der Voort Peter H J
Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Executive Board Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Healthcare (Basel). 2022 Oct 25;10(11):2122. doi: 10.3390/healthcare10112122.
In view of the shortage of medical staff, the quality and continuity of care may be improved by employing advanced practice providers (APPs). This study aims to assess the quality of these APPs in critical care. In a large teaching hospital, rapid response team (RRT) interventions led by APPs were assessed by independent observers and intensivists and compared to those led by medical residents MRs. In addition to mortality, the MAELOR tool (assessment of RRT intervention), time from RRT call until arrival at the scene and time until completion of clinical investigations were assessed. Process outcomes were assessed with the crisis management skills checklist, the Ottawa global rating scale and the Mayo high-performance teamwork scale. The intensivists assessed performance with the handoff CEX recipient scale. Mortality, MAELOR tool, time until arrival and clinical investigation in both groups were the same. Process outcomes and performance observer scores were also equal. The CEX recipient scores, however, showed differences between MRs and APPs that increased with experience. Experienced APPs had significantly better situational awareness, better organization, better evaluations and better judgment than MRs with equal experience (p < 0.05). This study shows that APPs perform well in leading an RRT and may provide added quality over a resident. RRTs should seriously consider the deployment of APPs instead of junior clinicians.
鉴于医护人员短缺，通过雇佣高级执业提供者（APPs）可能会提高护理质量和连续性。本研究旨在评估这些APPs在重症监护中的质量。在一家大型教学医院，由独立观察员和重症监护医生对由APPs领导的快速反应小组（RRT）干预措施进行评估，并与由住院医生（MRs）领导的干预措施进行比较。除了死亡率外，还评估了MAELOR工具（RRT干预评估）、从RRT呼叫到到达现场的时间以及完成临床检查的时间。使用危机管理技能清单、渥太华全球评分量表和梅奥高效团队合作量表对过程结果进行评估。重症监护医生使用交接CEX接受者量表评估表现。两组的死亡率、MAELOR工具、到达时间和临床检查情况相同。过程结果和表现观察者评分也相等。然而，CEX接受者评分显示，MRs和APPs之间存在差异，且随着经验的增加而增大。经验丰富的APPs在态势感知、组织能力、评估能力和判断力方面明显优于具有同等经验的MRs（p < 0.05）。本研究表明，APPs在领导RRT方面表现出色，可能比住院医生提供更高的质量。RRTs应认真考虑部署APPs而非初级临床医生。
