ArticleChest2014
Nurse practitioner/physician assistant staffing and critical care mortality.
Article in Chest, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 102 citations in OpenAlex.
- Availability of Advanced Practice Providers in Adult Intensive Care Units in the United States: A Survey.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2025Article
- Physician Assistants/Associates in Critical Care: A Descriptive Analysis Using the National Commission on Certification of Physician Assistants Dataset.Critical care explorations · 2025Article
- Interprofessional Team Staffing in U.S. Intensive Care Units.Annals of the American Thoracic Society · 2025Article
- [Academised nursing in direct patient care-but how?]Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
- Gamification in Critical Care Education and Practice.Critical care explorations · 2024Article
- Value of Nurse Practitioner Inpatient Hospital Staffing.Medical care · 2021Article
- The Society of Critical Care Medicine at 50 Years: ICU Organization and Management.Critical care medicine · 2021Article
- Article
- Comparison of the Outcome of Patient Management with Physician Extenders Only and with both Residents and Extenders.Cureus · 2020Article
- Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018.Critical care medicine · 2019Review
- Service-Based Advanced Practice Providers: The Surgeon's Perspective.The American surgeon · 2019Article
- The impact of advanced practice providers on the surgical resident experience: Agree to disagree?American journal of surgery · 2019Article
- Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients.Journal of evaluation in clinical practice · 2018Article
- Advanced Critical Care Practitioners - Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit.Journal of the Intensive Care Society · 2018Article
- Article
- Article
- The Association Between Daytime Intensivist Physician Staffing and Mortality in the Context of Other ICU Organizational Practices: A Multicenter Cohort Study.Critical care medicine · 2015Article
- Differences between nurse- and physician-assessed ICU characteristics using a standardized survey.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2015Article
- Teamwork in the intensive care unit.The American psychologistReview
- Shortage of intensive care specialists in the United States: recent insights and proposed solutions.Revista Brasileira de terapia intensivaArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundICUs are increasingly staffed with nurse practitioners/physician assistants (NPs/PAs), but it is unclear how NPs/PAs influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for patients in the ICU.
methodsWe used retrospective cohort data from the 2009 to 2010 APACHE (Acute Physiology and Chronic Health Evaluation) clinical information system and an ICU-level survey. We included patients aged ≥ 17 years admitted to one of 29 adult medical and mixed medical/surgical ICUs in 22 US hospitals. Because this survey could not assign NPs/PAs to individual patients, the primary exposure was admission to an ICU where NPs/PAs participated in patient care. The primary outcome was patient-level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NPs/PAs on in-hospital mortality, accounting for differences in case mix, ICU characteristics, and clustering of patients within ICUs. We also examined this relationship in the following subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (> 55), and ICUs with low-intensity physician staffing and with physician trainees.
resultsTwenty-one ICUs (72.4%) reported NP/PA participation in direct patient care. Patients in ICUs with NPs/PAs had lower mean Acute Physiology Scores (42.4 vs 46.7, P < .001) and mechanical ventilation rates (38.8% vs 44.2%, P < .001) than ICUs without NPs/PAs. Unadjusted and risk-adjusted mortality was similar between groups (adjusted relative risk, 1.10; 95% CI, 0.92-1.31). This result was consistent in all examined subgroups.
conclusionsNPs/PAs appear to be a safe adjunct to the ICU team. The findings support NP/PA management of critically ill patients.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.