Comparison of neonatal nurse practitioners, physician assistants, and residents in the neonatal intensive care unit.

OBJECTIVE: To compare patient care delivery by neonatal nurse practitioners and physician assistants with that of pediatric residents in the intensive care setting.

DESIGN: Retrospective chart review after developing specific performance criteria, namely, patient management, outcome, and charges.

METHODS/MATERIALS: Charts for 244 consecutive admissions to a neonatal intensive care unit in Jacksonville, Fla, were reviewed. Patients were cared for by one of two teams, one staffed by residents and the other by neonatal nurse practitioners and physician assistants. Similar patients were cared for by the two teams, as determined by patient background characteristics and diagnostic variables. Performance of the two teams was assessed by comparison of patient management, outcome, and charges. Management variables included data on length of critical care and hospital stay, ventilator and oxygen use, total parenteral nutritional use, number of transfusions, and the performance of various procedures. Outcome variables included the incidence of air leaks, bronchopulmonary dysplasia, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, and number of infants who died. Charge variables included hospital and physician charges.

MAIN RESULTS: Results demonstrated no significant differences in management, outcome, or charge variables between patients cared for by the two teams.

CONCLUSION: Neonatal nurse practitioners and physician assistants are an effective alternative to residents for patient care in the neonatal intensive care unit.