Background Acute care nurse practitioners have been successfully integrated into inpatient settings. They perform invasive procedures in the intensive care unit and other acute care settings. Although their general scope of practice is regulated at the state level, local and regional scope of practice is governed by hospitals. Objective To determine if credentialing and privileging of these nurses for invasive procedures varies depending on the institution. Methods Personnel in medical staff offices of 329 hospitals were surveyed by telephone with 6 questions. Data collected included acute care nurse practitioner and hospital demographics, frequency and type of procedures performed, proctoring and credentialing process, and the presence of residents and fellows at the institution. Results The response rate was 74.8% (246 hospitals). Among these, 48% (118) employed acute care nurse practitioners, of which 43.2% performed invasive procedures. Three hospitals were excluded from the final analysis. Of the hospitals that credentialed and granted privileges to the nurse practitioners for invasive procedures, 60.4% were teaching hospitals. A supervising physician was the proctor in 94% of the nonteaching hospitals and 100% of the teaching hospitals. The most common number of cases proctored was 4 to 7. Conclusion The majority of hospitals employ acute care nurse practitioners. The most common method of privileging for invasive procedures is proctoring by a supervising physician. However, the amount of proctoring required before privileges and independent practice are granted varies by procedure and institution.

Introduction: Today, critical care in the United States costs more than $80 billion annually. With an aging population and the growing demand for critical care, it is predicted that the number of staffed intensive care unit (ICU) beds will become increasingly inadequate. Limited resources, intensivists, and ICU beds warrant investigating models for predicting who will benefit from admission to the ICU. This study presents a possible model for identifying patients who might be too well to benefit from admission to the ICU. Methods: We retrospectively identified all patients admitted to our 54 bed medical-surgical ICU between 11/2009 and 2/2013. We used the APACHE Outcomes database to identify patients who on day one of ICU admission received one or more of 33 subsequent active life supporting treatments. We compared two groups of patients: Low Risk Monitor (LRM) (Patients who did not receive active treatment on the first day and whose risk of ever receiving active treatment was <= 10 %) and Active Treatment (AT) (patients who received at least 1 of the 33 ICU treatments on any day of their ICU admission). Results: There were 2293 admissions (29.7%) in the LRM group, and 5430 admissions (70.3%) in the AT group. APACHE IV score was 34.3 (+/-13.4) for the LRM group versus 58.7 (+/-25) for the AT group (P < 0.0001). ICU length of stay (LOS) in days was 1.6 (+/-1.7) for the LRM group versus 4.3 (+/-5.3) for the AT group (P < 0.0001). ICU mortality was 0.7 % for the LRM group compared to 9.6 % for the AT group (OR = 15.0; 95% confidence interval [CI], 9.2 -24.8, p <0.0001). Hospital mortality was 1.8 % for the LRM group compared to 15.2 % for the AT group (OR = 9.8; 95% CI, 7.1 -13.4, p <0.0001). Conclusions: The outcome for low-risk monitor patients in our ICU suggests they may not require admission to intensive care. This may provide a measure of ICU resource use. Improved resource use and reduced costs might be achieved by strategies to provide care for these patients on floors or intermediate care units. This model will need to be validated in other ICUs and prospectively studied before it can be adopted for triaging admissions to ICUs.

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