Comparison of procedural complications between resident physicians and advanced clinical providers

In the era of resident work hour restrictions, many trauma centers across the country have incorporated advanced clinical providers (ACPs) as integral partners in the care of critically ill patients. In addition to providing daily care, ACPs have also begun performing invasive procedures. Few studies have addressed ACPs procedural complications. The purpose of this study was to compare the complication rates from surgical procedures performed by resident physicians (RPs) and ACPs in the critical care setting.

We conducted a retrospective review of all procedures performed from January to December of 2011 in our trauma and surgical intensive care units. Under attending supervision, ACPs performed procedures for surgical critical care patients and RPs for trauma patients. Procedures consisted of arterial lines, central venous lines, bronchoalveolar lavage, thoracostomy tubes, percutaneous endoscopic gastrostomy, and tracheostomies. Data included demographics, Acute Physiology and Chronic Health Evaluation III scores, complications, and outcomes and were divided into RP versus ACP groups. Complications were assessed by postprocedure radiography, operative notes, and postprocedure notes. Dichotomous data were compared using χ and continuous variables by Student's t tests.

There were a total of 1,404 patients; the mean ± SE Acute Physiology and Chronic Health Evaluation III score for patients in the RP group was 40.8 ± 0.9 compared with ACP group at 47.7 ± 0.7 (p < 0.05). Our RPs performed 1,020 procedures, and 21 complications were noted (complication rate, 2%). The ACPs completed 555 procedures; 11 complications were incurred (complication rate, 2%). There were no difference in the mean ± SE intensive care unit (RP, 3.9 ± 0.2 days vs. ACP, 3.7± 0.1 days) and hospital (RP, 12.2 ± 0.4 days vs. ACP, 13.3 ± 0.3 days) length of stay. Mortality rates were also comparable between the two groups (RP, 11% vs. ACP, 9.7%).

In critically ill patients, ACPs can competently perform invasive procedures safely. Our ACPs' responsibilities can be expanded to include invasive procedures in the critical care setting with appropriate supervision.

Therapeutic study, level IV.