Ralph T Perry, John W Weimer, Carrie Pratt, Marci D Newcome, Gabor Bagameri, J Kyle Bohman
{"title":"由执业护士和医生助理领导的心血管外科术后重症监护室人员配备模式。","authors":"Ralph T Perry, John W Weimer, Carrie Pratt, Marci D Newcome, Gabor Bagameri, J Kyle Bohman","doi":"10.1177/08850666241268458","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS).</p><p><strong>Design: </strong>Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway.</p><p><strong>Setting: </strong>A large tertiary referral academic cardiac surgery ICU.</p><p><strong>Participants: </strong>There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase.</p><p><strong>Interventions: </strong>Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model.</p><p><strong>Measurements and main results: </strong>Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (<i>P</i> = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (<i>P</i> = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (<i>P</i> = .30).</p><p><strong>Conclusions: </strong>Overall, implementation of an NP/PA-led postcardiac surgical ICU team (<i>rapid recovery pathway</i>) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model.\",\"authors\":\"Ralph T Perry, John W Weimer, Carrie Pratt, Marci D Newcome, Gabor Bagameri, J Kyle Bohman\",\"doi\":\"10.1177/08850666241268458\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS).</p><p><strong>Design: </strong>Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway.</p><p><strong>Setting: </strong>A large tertiary referral academic cardiac surgery ICU.</p><p><strong>Participants: </strong>There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase.</p><p><strong>Interventions: </strong>Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model.</p><p><strong>Measurements and main results: </strong>Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (<i>P</i> = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (<i>P</i> = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (<i>P</i> = .30).</p><p><strong>Conclusions: </strong>Overall, implementation of an NP/PA-led postcardiac surgical ICU team (<i>rapid recovery pathway</i>) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.</p>\",\"PeriodicalId\":16307,\"journal\":{\"name\":\"Journal of Intensive Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/08850666241268458\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/08850666241268458","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model.
Objectives: To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS).
Design: Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway.
Setting: A large tertiary referral academic cardiac surgery ICU.
Participants: There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase.
Interventions: Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model.
Measurements and main results: Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (P = .30).
Conclusions: Overall, implementation of an NP/PA-led postcardiac surgical ICU team (rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.
期刊介绍：
Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.
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