Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model

• Published in: Journal of intensive care medicine 2025-02, Vol.40 (2), p.178-183
• Main Authors: Perry, Ralph T., Weimer, John W., Pratt, Carrie, Newcome, Marci D., Bagameri, Gabor, Bohman, J. Kyle
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Surgical Procedures - statistics & numerical data; Female; Humans; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Middle Aged; Nurse Practitioners; Patient Readmission - statistics & numerical data; Personnel Staffing and Scheduling - organization & administration; Personnel Staffing and Scheduling - statistics & numerical data; Physician Assistants - statistics & numerical data; Postoperative Care - methods; Postoperative Care - statistics & numerical data; Retrospective Studies; Workforce
• ISSN: 0885-0666; 1525-1489; 1525-1489
• DOI: 10.1177/08850666241268458

Objectives To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). Design Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. Setting A large tertiary referral academic cardiac surgery ICU. Participants There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. Interventions Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. Measurements and Main Results Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (P = .30). Conclusions Overall, implementation of an NP/PA-led postcardiac surgical ICU team (rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.