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Midlevel Health Providers Impact on ICU Length of Stay, Patient Satisfaction, Mortality, and Resource Utilization

Medeiros, Regina S DNP, MHSA, RN; NeSmith, Elizabeth G. PhD, MSN, RN; Heath, Janie A. PhD, APRN-BC, FAAN; Hawkins, Michael L. MD, FACS; Hawkins, Debbie RN, MSN; Bias, Richard FACHE

doi: 10.1097/JTN.0b013e31822b7faf

The purpose of this systematic review is to evaluate midlevel practitioner practice on intensive care unit (ICU) outcomes: patient satisfaction, length of stay, mortality and resource utilization/cost. MEDLINE (1982–2007) and CINAHL (1982–2007) were used to identify research examining midlevel practitioner ICU outcomes. Although extensive research has occurred in pediatric and primary care settings, few studied adult ICU outcomes. Four of 5 studies reviewed reported positive impacts on length of stay. Only 1 study addressed patient satisfaction. Mortality and cost outcomes varied, finding both differences and no differences. These results support vitally needed research investigating midlevel practitioner impact on adult ICU outcomes.

Georgia Health Sciences Health System, Augusta, Georgia (Dr Medeiros, Mrs Hawkins and Bias); Georgia Health Sciences University College of Nursing, Augusta (Drs NeSmith and Heath); and Georgia Health Sciences University, Medical College of Georgia, Department of Surgery, Section of Trauma, Augusta (Dr Hawkins).

Correspondence: Regina S Medeiros, DNP, MHSA, RN, Georgia Health Sciences Medical Center, 1120 15th St, Room BA-4411, Augusta, GA 30912 (

© 2011 Society of Trauma Nurses