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Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care
Kristin H Gigli1,2, Billie S Davis1, Grant R Martsolf3,4
1Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
Pediatric intensive care units (PICUs) with advanced practice providers (APPs) showed no increased mortality in younger, sicker children. APP staffing was linked to fewer hospital-acquired infections, improving pediatric critical care outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Staffing Models
- Advanced Practice Providers
Background:
- Pediatric intensive care units (PICUs) are increasingly integrating advanced practice providers (APPs) alongside traditional physician staffing.
- This shift aims to supplement physician expertise and potentially enhance patient care delivery in critical settings.
Purpose of the Study:
- To evaluate the impact of pediatric intensive care unit (PICU) staffing models that include advanced practice providers (APPs) on clinical outcomes.
- To assess the effect of APP-inclusive staffing on resource utilization within US PICUs.
Main Methods:
- A retrospective cohort study analyzed data from 38,788 children admitted to 40 PICUs across 9 states in 2016.
- Healthcare Cost and Utilization Project's State Inpatient Databases were used, with staffing models assessed via a survey.
- Multivariate regression examined associations between APP-inclusive and physician-only staffing models and patient outcomes.
Main Results:
- Patients in APP-inclusive PICUs were younger and had higher rates of complex chronic conditions and organ failure upon admission.
- No significant difference in in-hospital mortality was observed between PICUs with and without APPs [AOR: 1.23, 95% CI: 0.83-1.81].
- APP-inclusive staffing was associated with lower odds of central line-associated bloodstream infections (AOR: 0.76) and catheter-associated urinary tract infections (AOR: 0.73).
Conclusions:
- Children in PICUs with APP-inclusive staffing experienced no increased mortality risk, despite being younger and sicker.
- APP integration in PICUs led to a reduction in specific hospital-acquired infections.
- Findings suggest that APP inclusion in PICU staffing can be safe and may reduce infection rates, warranting further research into optimal integration strategies.
Background:
Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.
Objectives:
We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.
Research Design:
Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.
Measures:
The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay.
Results:
The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay.
Conclusions:
Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.
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