• Kazuhide Matsushima, Kenji Inaba, Dimitra Skiada, Michael Esparza, Jayun Cho, Tim Lee, Aaron Strumwasser, Gregory Magee, Daniel Grabo, Lydia Lam, Elizabeth Benjamin, Howard Belzberg, and Demetrios Demetriades.
• Division of Acute Care Surgery, University of Southern California, Los Angeles, CA. Electronic address: kazuhide.matsushima@med.usc.edu.
• J Crit Care. 2016 Jun 1; 33: 4-7.

PurposeIt remains unknown whether critically ill trauma patients can be successfully managed by advanced practitioners (APs). The purpose of this study was to examine the impact of night coverage by APs in a high-volume trauma intensive care unit (ICU) on patient outcomes and care processes.Materials And MethodsDuring the study period, our ICU was staffed by APs during the night shift (7 pm-7 am) from Sunday to Wednesday and by resident physicians (RPs) from Thursday to Saturday. On-call trauma fellows and attending surgeons in house supervised both APs and RPs. Patient outcomes and care processes by APs was compared with those admitted by RPs.ResultsA total of 289 patients were identified between July 2013 and February 2014. Median lactate clearance rate within 24 hours of admission was similar between study groups (10.0% vs 9.1%; P = .39). Advanced practitioners and RPs transfused patients requiring massive transfusion with a similar blood product ratio (packed red blood cell:fresh frozen plasma) (2.1:1 vs 1.7:1; P = .32). In a multiple logistic regression analysis, AP coverage was not associated with any clinical outcome differences.ConclusionsOur data suggest that, with adequate supervision, a high-volume trauma ICU can be safely staffed by APs overnight.Copyright © 2016 Elsevier Inc. All rights reserved.

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