Kristin H Gigli1,2, Billie S Davis1, Grant R Martsolf3,4, Jeremy M Kahn1,5. 1. Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2. College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX. 3. Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing. 4. RAND Corporation. 5. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Abstract
BACKGROUND: Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models. OBJECTIVES: We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs. RESEARCH DESIGN: Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes. MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay. RESULTS: The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay. CONCLUSIONS: Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.
BACKGROUND: Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models. OBJECTIVES: We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs. RESEARCH DESIGN: Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes. MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay. RESULTS: The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay. CONCLUSIONS: Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.
Authors: Eileen R Sherman; Kateri H Heydon; Keith H St John; Eva Teszner; Susan L Rettig; Sharon K Alexander; Theoklis Z Zaoutis; Susan E Coffin Journal: Infect Control Hosp Epidemiol Date: 2006-03-29 Impact factor: 3.254
Authors: Meeta Prasad Kerlin; Neill K J Adhikari; Louise Rose; M Elizabeth Wilcox; Cassandra J Bellamy; Deena Kelly Costa; Hayley B Gershengorn; Scott D Halpern; Jeremy M Kahn; Meghan B Lane-Fall; David J Wallace; Curtis H Weiss; Hannah Wunsch; Colin R Cooke Journal: Am J Respir Crit Care Med Date: 2017-02-01 Impact factor: 21.405
Authors: Leslie A Hoffman; Frederick J Tasota; Thomas G Zullo; Carmella Scharfenberg; Michael P Donahoe Journal: Am J Crit Care Date: 2005-03 Impact factor: 2.228