Involvement of advanced care practitioners (ACPs) like physician assistants and advanced clinical nurses has increased significantly due to the implementation of work hour restrictions for surgical residents. Prior to this, invasive procedures were performed almost exclusively by the residents. Now, more and more procedures are being performed by ACPs. The question is: is it safe?
Carolinas Medical Center retrospectively reviewed all ICU procedures performed in a year’s time in their SICU. They compared complication rates when the procedure was performed by a resident vs an ACP.
The factoids:
- Procedures reviewed included arterial lines, central venous lines, chest tubes, bronchoalveolar lavage, perc gastrostomy, and perc tracheostomy
- Residents performed all procedures on trauma patients in the ICU, and ACPs performed procedures on all other SICU patients (note: this is not randomization!)
- All procedures were supervised by an attending physician
- A total of 1,575 procedures were performed, 1,020 by residents and 555 by ACPs
- The complication rate for both groups was 2% (no difference)
- Hospital and ICU length of stay were the same for both groups
- In-hospital mortality was 11% for the resident group vs 9.7% for the ACP group, despite higher APACHE III for the latter.
Bottom line: ACPs can perform ICU level procedures as well as residents with proper supervision. As work hour restrictions continue to become more restrictive, expect to see further degradation of resident experience and expanded involvement of ACPs. For centers without residents, be confident in expanding the role of your ACPs in clinical care.
Related posts:
Reference: Comparison of critical care procedural complication rates between residents and advanced clinical providers. EAST 2014, oral paper 21.
