Utilization of PAs and NPs at a level I trauma center: effects on outcomes

This study analyzes the impact of midlevel practitioners (MLPs) on patient care and resource utilization at a level I trauma center.

A retrospective review of trauma patients admitted during two periods was performed: PRE-MLP, during which limited MLP coverage was available; and POST-MLP, when MLP coverage was expanded. Demographics, injury severity scores (ISS), and preexisting medical conditions (PEC) were recorded. Trauma service activity was measured by daily admissions, inpatient census, and daily discharges. Outcome variables included hospital mortality, total length of stay (HLOS), ICU length of stay (ICU-LOS), and incidence of the three most prevalent complications: deep vein thrombosis (DVT), major arrhythmia (MA), urinary tract infection (UTI).

PRE-MLP and POST-MLP groups were similar with respect to age, gender, and ISS. Mean daily admissions were 3.05 during the PRE-MLP period and 4.01 during the POST-MLP period (P = .0001). Reduced incidence of UTI was demonstrated in the POST-MLP period: 0.9% versus 2.6% (P = .0001). Incidence of DVT and MA were unchanged. HLOS decreased from 5.09 days to 4.84 days (P = .092). ICU-LOS was reduced from 4.08 days to 3.28 days (P = .019).

Use of MLPs led to a significant reduction in ICU-LOS with no increased incidence of complications. MLPs offer a clinically effective and resource-efficient alternative to residents on a trauma service.