Procedures Performed by Advanced Practice Providers Compared With Medical Residents in the ICU: A Prospective Observational Study

Abstract

Objective: To assess the frequency and safety of procedures performed by advanced practice providers and medical residents in a mixed-bed ICU. Design: A prospective observational study where consecutive invasive procedures were studied over a period of 1 year and 8 months. The interventions were registered anonymously in an online database. Endpoints were success rate at first attempt, number of attempts, complications, level of supervision, and teamwork. Setting: A 33-bedded mixed ICU. Subjects: Advanced practice providers and medical residents. Interventions: Registration of the performance of tracheal intubation, central venous and arterial access, tube thoracostomies, interhospital transportation, and electrical cardioversion. Measurement and Main Results: A full-time advanced practice provider performed an average of 168 procedures and a medical resident an average of 68. The advanced practice provider inserted significant more radial, brachial, and femoral artery catheters (66% vs 74%, p = 0.17; 15% vs 12%, p = 0.14; 18% vs 14%, p = 0.14, respectively). The median number of attempts needed to successfully insert an arterial catheter was lower, and the success rate at first attempt was higher in the group treated by advanced practice providers (1.30 [interquartile range, 1–1.82] vs 1.53 [interquartile range, 1–2.27], p < 0.0001; and 71% vs 54%, p < 0.0001). The advanced practice providers inserted more central venous catheters (247 vs 177) with a lower median number of attempts (1.20 [interquartile range, 1–1.71] vs 1.33 [interquartile range, 1–1.86]) and a higher success rate at first attempt (81% vs 70%; p < 0.005). The number of intubations by advanced practice providers was 143 and by medical residents was 115 with more supervision by the advanced practice provider (10% vs 0%; p = 0.01). Team performance, as reported by nursing staff, was higher during advanced practice provider procedures compared with medical resident procedures (median, 4.85 [interquartile range, 4.85–5] vs 4.73 [interquartile range, 4.22–5]). Other procedures were also more often performed by advanced practice providers. The complication rate in the advanced practice provider–treated patient group was lower than that in the medical resident group. Conclusions: Advanced practice providers in critical care performed procedures safe and effectively when compared with medical residents. Advanced practice providers appear to be a valuable addition to the professional staff in critical care when it comes to invasive procedures.

Advanced practice providers in critical care improve team performances. A post-hoc analysis of the BASIC trial

“…Recent research on APPs in critical care often focused on the evaluation of clinical patient-related outcomes and performances of these APPs in conjunction with a coordinating medical specialist. (2)(3)(4) In this study the non-technical skills of APPs and residents as leaders of a RRT were assessed without this additional consultation. APPs performed better than residents in several subcategories and omitted overall less predefined critical steps.…”

Declining Procedures in Pediatric Critical Care Medicine Using a National Database

“…However, there has also been an increase in the number of providers (trainees and faculty) in PCCM as indicated by the ABP Physician Workforce Data ( 2 , 3 ). Further, this analysis does not include the likely increasing contribution of nurse practitioners, physician assistants, and airway rapid response team involvement in PICU procedures ( 8 , 9 ). Although total procedures have increased, as providers have also increased, physicians may not have the same opportunity to perform invasive procedures that they did previously, most notably for CVC placement.…”

Advanced Practice Providers as Leaders of a Rapid Response Team: A Prospective Cohort Study

“…Nevertheless, this study is in line with other studies about patient and technical skill outcomes. Although APPs often perform relatively more technical and non-technical skills when comparing the number of APPs to the number MRs, this study underscores the difficulty of assessing the APP without their team and using the right tools to measure the added value of an APP [ 12 , 28 , 29 , 30 ].…”