Health Professionals in Critical Care

  • Timothy G. BuchmanEmail author
Part of the Respiratory Medicine book series (RM, volume 18)


Critical care is commonly delivered by an integrated multiprofessional team. Clinical operations that attain peak performance depend on familiarity with the training, professional scope, and capabilities of each team member. This chapter focuses on non-physician team roles and reviews evidence supporting their collective contributions to better health, better care, and lower costs. While every ICU is likely to have a division of labor reflecting local skill sets and historic work flows, the data suggest that evidence-based, need-driven reallocation of tasks across the professional team can improve outcomes without incurring additional expense.


Critical care Nurse Nurse practitioner Physician assistant Respiratory therapist Dietitian Pharmacist Value Cost of care 


  1. 1.
    Safar P, et al. The intensive care unit. A three year experience at Baltimore city hospitals. Anaesthesia. 1961;16:275–84.PubMedCrossRefGoogle Scholar
  2. 2.
    AACN: CCRN credential position statement. (2013). Cited 15 April 2013.
  3. 3.
    Cullen DJ, et al. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med. 1974;2(2):57–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Penoyer DA. Nurse staffing and patient outcomes in critical care: a concise review. Crit Care Med. 2010;38(7):1521–8. quiz 1529.PubMedCrossRefGoogle Scholar
  5. 5.
    Zolnierek CD, Steckel CM. Negotiating safety when staffing falls short. Crit Care Nurs Clin North Am. 2010;22(2):261–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Goran SF. Measuring tele-ICU impact: does it optimize quality outcomes for the critically ill patient? J Nurs Manag. 2012;20(3):414–28.PubMedCrossRefGoogle Scholar
  7. 7.
    Esteban A, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Mathews P, Drumheller L, Carlow JJ. Respiratory care manpower issues. Crit Care Med. 2006;34(3 Suppl):S32–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Warren DK, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31(5):1312–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Rello J, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Cocanour CS, et al. Cost of a ventilator-associated pneumonia in a shock trauma intensive care unit. Surg Infect (Larchmt). 2005;6(1):65–72.CrossRefGoogle Scholar
  12. 12.
    Leape LL, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267–70.PubMedCrossRefGoogle Scholar
  13. 13.
    Klopotowska JE, et al. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care. 2010;14(5):R174.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: risk factors, impact, and the role of team care. Crit Care Med. 2010;38(6 Suppl):S83–9.PubMedCrossRefGoogle Scholar
  15. 15.
    McCarthy C, O’Rourke NC, Madison JM. Integrating advanced practice providers into medical critical care teams. Chest. 2013;143(3):847–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Garland A, Gershengorn HB. Staffing in ICUs: physicians and alternative staffing models. Chest. 2013;143(1):214–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Gershengorn HB, et al. Impact of nonphysician staffing on outcomes in a medical ICU. Chest. 2011;139(6):1347–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Cramer CL, Orlowski JP, DeNicola LK. Pediatric intensivist extenders in the pediatric ICU. Pediatr Clin North Am. 2008;55(3):687–708. xi–xii.PubMedCrossRefGoogle Scholar
  19. 19.
    Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review. Crit Care Med. 2008;36(10):2888–97.PubMedCrossRefGoogle Scholar
  20. 20.
    Carpenter DL, et al. Patient-care time allocation by nurse practitioners and physician assistants in the intensive care unit. Crit Care. 2012;16(1):R27.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Doig GS, et al. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018–27.PubMedCrossRefGoogle Scholar
  22. 22.
    Cahill NE, et al. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010;38(2):395–401.PubMedCrossRefGoogle Scholar
  23. 23.
    Herridge MS, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.PubMedCrossRefGoogle Scholar
  24. 24.
    de Jonghe B, et al. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37(10 Suppl):S309–15.PubMedCrossRefGoogle Scholar
  25. 25.
    Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300(14):1685–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Truong AD, et al. Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials. Crit Care. 2009;13(4):216.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    McCoach RM, et al. The new role of the perfusionist in adult extracorporeal life support. Perfusion. 2010;25(1):21–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim MM, et al. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369–76.PubMedCrossRefGoogle Scholar
  29. 29.
    Pronovost PJ, et al. Team care: beyond open and closed intensive care units. Curr Opin Crit Care. 2006;12(6):604–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Levy MM, et al. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148(11):801–9.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Petitti D, Bennett V, Chao Hu CK. Association of changes in the use of board-certified critical care intensivists with mortality outcomes for trauma patients at a well-established level I urban trauma center. J Trauma Manag Outcomes. 2012;6:3.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Hackner D, et al. Do faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU? Hosp Pract (1995). 2009;37(1):40–50.CrossRefGoogle Scholar
  33. 33.
    Wallace DJ, et al. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med. 2012;366(22):2093–101.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Netzer G, et al. Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit. Crit Care Med. 2011;39(2):284–93.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Butler KL, et al. Optimizing advanced practitioner charge capture in high-acuity surgical intensive care units. Arch Surg. 2011;146(5):552–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Emory Center for Critical CareEmory University Hospital, Woodruff Health Science Center Administration Building (WHSCAB)AtlantaUSA
  2. 2.Surgery and AnesthesiologyEmory University School of MedicineAtlantaUSA

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