Availability of Advanced Practice Providers in Adult Intensive Care Units in the United States: A Survey

Abstract

Background How advanced practice providers (APPs) are deployed in adult US intensive care units (ICUs) is under-studied. Further, whether state-level restrictions on practice affect the availability of these providers is unknown. Objectives To describe staffing patterns of ICU APPs (nurse practitioners, physician assistants) in the context of physicians-in-training (interns, residents, fellows) and to explore the association between state-level APP practice restrictions and employment. Methods Data from a national survey of pre–COVID-19 (steady-state) ICU staffing linked to the 2020 American Hospital Association survey were used to examine staffing patterns (via descriptive statistics) and to explore the association of state-level practice restrictions with the presence of APPs in ICUs (via multivariable regression). Results The cohort included 588 adult ICUs, of which 336 (57.1%) reported both APPs and physicians-in-training, 124 (21.1%) APPs only, 73 (12.4%) physicians-in-training only, and 55 (9.4%) neither. Units with both provider types were more commonly surgical ICUs (17.6% vs ≤9.6%; P