Implementation of an interprofessional staffing model: Utilizing nurse practitioners and the eICU

Area of Science:

• Critical Care Medicine
• Healthcare Staffing Solutions
• Quality Improvement Initiatives

Background:

• Addressing critical care provider shortages, burnout, and attrition.
• Leveraging evidence supporting the safe use of nurse practitioners (NPs) and physician assistants (PAs) in ICUs.
• Facing staffing challenges due to shortages and increased clinical responsibilities within an ICU team.

Purpose of the Study:

• To evaluate the feasibility, safety, and effectiveness of utilizing NPs and PAs overnight in a community medical/surgical ICU.
• To assess the impact of this staffing model on patient outcomes and staff satisfaction.

Main Methods:

• An evidence-based, pre-post quality improvement project.
• Implementing NPs and PAs for overnight coverage, replacing intensivists, supported by an eICU.
• Measuring mortality, procedural complications, CLABSI, and CAUTI rates pre- and post-implementation; collecting qualitative data on facilitators and barriers.

Main Results:

• Zero catheter-associated urinary tract infection (CAUTI) rates pre- and post-implementation.
• Central line-associated bloodstream infection (CLABSI) rates decreased from one to zero.
• >90% of respondents reported positive effects on quality and communication; facilitators included collaboration and accessibility, while barriers involved role understanding and inter-service communication.

Conclusions:

• A collaborative overnight model with NPs and PAs is a feasible, safe, and effective ICU staffing solution.
• The hybrid model enhanced support for NPs, PAs, and nursing staff, improving transition and satisfaction.
• Further multi-site research is recommended to validate NP and PA implementation in hybrid ICU models nationally.