Background Since April 2016, nurse practitioners (NPs) have provided inter-professional team collaborative care for postoperative patients in our intensive care unit (ICU). To assess the effectiveness of NP practice, we compared patient outcomes with and without NP care in our ICU.
Methods This retrospective observational cohort study was undertaken at Aichi Medical University Hospital in Japan from 01 April 2015 and 31 March 2017. Mechanically-ventilated postoperative patients who stayed in the ICU for >2 days were eligible for inclusion. We compared the patient outcomes between the period without NP care from April 2015 to March 2016 (physician group) and the period with NP care from April 2016 to May 2017 (NP-physician group). The primary outcome was ICU length of stay. Secondary outcomes were mechanical ventilation days and total hospital length of stay. To further determine the factors associated with ICU length of stay, multiple regression analysis was performed for age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, NP-physician group, and physician group.
Results A total of 387 patients were included in the study. Among these patients, 213 were assigned to the NP-physician group and 174 were assigned to the physician group. The NP-physician group had shorter ICU length of stay than the physician group (4.8 ± 4.8 days versus 6.7 ± 10.3 days, p < 0.021). There were no significant differences between the two groups in mechanical ventilation days or total hospital length of stay. In the multiple regression analysis for ICU length of stay, APACHE II score and NP-physician group were associated with ICU length of stay. Specifically, NP-physician group reduced ICU length of stay by 2.6 days ( p = 0.003), and APACHE II score one-point decrease reduced ICU length of stay by 0.2 days ( p = 0.012).
Conclusions The present study demonstrated shorter ICU length of stay in patients with NP care and a significant association between NP participation in the ICU team and ICU length of stay.