Comparison of Procedural Complications Between Resident Physicians and Advanced Clinical Providers

This study compared the complication rates of invasive procedures completed by resident physicians compared with invasive procedures completed by advanced care providers (ACP) in intensive care units (ICU) in a single center. This paper is a retrospective review of the procedures conducted during a 1-year period. The ACPs were evaluated for procedures performed in a surgical critical care unit. Resident providers were evaluated for procedures performed in a trauma critical care unit. The procedures included in the comparison were central lines, arterial lines, chest tubes, bronchoalveolar lavage, tracheostomies, and endoscopic gastrostomy. There were a total of 1401 patients in the study. Residents performed 1020 procedures with a 2% complication rate. ACPs performed 555 procedures and also had a 2% complication rate. A range of other variables (length of intensive care unit stay, length of hospital stay and mortality) were also similar between the groups. There were no procedure-related deaths in either group. The ACPs in the study had participated in postgraduate education and had been certified in each procedure before they were evaluated. ACPs had 1 to 7 years of experience. Resident physicians were second-year general surgery and emergency medicine residents. APACHE III scores for the ACP patients were significantly higher than those for the resident physician patients. This is was likely due to the age difference and comorbidities of the surgical ICU patients treated by the ACPs compared with the trauma ICU patients treated by the resident physicians. The ACP procedures were also done on patients consulted by other services in the hospital, which had been a consult to the surgical ICU.