• Leslie A Hoffman, Frederick J Tasota, Thomas G Zullo, Carmella Scharfenberg, and Michael P Donahoe.
• Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
• Am. J. Crit. Care. 2005 Mar 1; 14 (2): 121-30; quiz 131-2.

BackgroundMany academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.ObjectiveTo compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.MethodsDuring a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.ResultsPatients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).ConclusionsIn a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

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