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American Journal of Critical Care. 2008;17: 357-363
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Outcomes of Tube Thoracostomies Performed by Advanced Practice Providers vs Trauma Surgeons

By Laura C. Bevis, MSN, ARNP, BC-ACNP, BC-FNP, Gina M. Berg-Copas, MA, Bruce W. Thomas, DO, Donald G. Vasquez, DO, MPH, Ruth Wetta-Hall, RN, PhD, David Brake, MD, Eddy Lucas, MD, Khaled Toumeh, MD and Paul Harrison, MD. Laura C. Bevis was a trauma nurse practitioner at Wesley Medical Center, Wichita, Kansas, at the time of the study, and is now an internal medicine hospitalist nurse practitioner for the Wichita Clinic.Bruce W. Thomas is a trauma surgeon/surgical intensivist and medical director of the surgical intensive care unit, Donald G. Vasquez is a trauma surgeon/surgical intensivist, Paul Harrison is a trauma surgeon and medical director of the trauma service, and David Brake is a radiologist, all at Wesley Medical Center. Eddy Lucas and Khaled Toumeh were radiologists at Wesley Medical Center at the time of the study. Gina M. Berg-Copas is a teaching associate and Ruth Wetta-Hall is an assistant professor in the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine–Wichita.

Corresponding author: Gina M. Berg-Copas, PHD(C), University of Kansas School of Medicine–Wichita, PMPH, 1010 N Kansas, Wichita, KS 67214-3199 (e-mail: gcopas{at}kumc.edu).

Background The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians’ capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians.

Objectives To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure.

Methods Retrospective blinded reviews of patients’ charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers.

Results Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good.

Conclusions Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.






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