Differences in Care Provided in Intensive Care Units (ICUs) With Physician Versus Nurse Practitioner First Responders

Completed

• Conditions: Critical Illness
• Interventions: Other: Medically directed care

• Registration Number: NCT01323816
• Lead Sponsor: Naeem Ali, MD

Brief Summary

The purpose of this study is to evaluate and compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including resident, pulmonary fellow and attending physician and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending.

Detailed Description

This will be a retrospective cohort study that is performed between two medical intensive care units (ICU). The goal is to compare outcomes of patients that have received care in medical intensive care units in a tertiary care facility with two different models; the traditional model including a resident, pulmonary fellow and attending and a nontraditional model which has Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending. Outcomes that will be measured include ICU length of stay, hospital length of stay after ICU discharge, ventilator days, daily spontaneous breathing trials, and daily awakening trials, as well as mortality in hospital and after discharge.

Study Timeline

• Study Start: 2011-03
• Study First Submitted: 2011-03-24
• Study First Submitted QC: 2011-03-24
• Study First Posted: 2011-03-28
• Primary Completion: 2014-05
• Study Completion: 2014-05
• Status Verified: 2014-06
• Last Update Submitted: 2014-06-25
• Last Update Posted: 2014-06-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 3659

Inclusion Criteria

• Patients admitted to designated ICU between September 1, 2007 and September 30, 2010.

Exclusion Criteria

• Not admitted to designated ICU.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Traditional	Medically directed care	ICU staffed by a resident, pulmonary fellow and attending
Non-Traditional	Medically directed care	ICU staffed by Nurse Practitioners as the direct care deliverer, a pulmonary fellow, and an attending

Primary Outcome Measures

Name	Time	Method
Life-years hospital costs	2007 - 2010	Life-years per $10,000 hospital costs - defined as the sum of days of survival after ICU admission for all patients admitted to each ICU/sum of all hospital costs for all patients admitted to each ICU

Secondary Outcome Measures

Name	Time	Method
Discharge location among survivors	2007 - 2010
Intensive Care Unit (ICU)Length of Stay (LOS)	2007 - 2010
Evidence-based care	2007 - 2010	% of ICU days receiving evidence-based care will also be explored as mediators of other outcomes); * Sedation holidays; * Spontaneous breathing trials; * Days with continuous infusions of sedatives; * Head of bed elevation
Intensive Care Unit (ICU) mortality	2007 - 2010
Hospital mortality	2007 - 2010
Time to death	2007 - 2010
Ventilator Days	2007 - 2010
Ventilator-free days	2007 - 2010	Days alive and not requiring mechanical ventilation in first 28 days after ICU admission
Intensive Care Unit (ICU)-free days	2007 - 2010	Days alive and not in the ICU in first 28 days after ICU admission
Hospital Length of Stay (LOS)	2007 - 2010
Hospital costs	2007 - 2010
Hospital charges	2007 - 2010
Patient Satisfaction Survey Results	2007 - 2010

Trial Locations

Locations (1)

The Ohio State University; 🇺🇸 Columbus, Ohio, United States