Nurse practitioner takes place of ICU doctor

Harford Memorial move affects many evening shifts

July 27, 2003|By Luciana Lopez | Luciana Lopez,SUN STAFF

Harford Memorial Hospital has begun using a nurse practitioner in the intensive care unit for about half of the unit's evening shifts because of a shortage of critical-care doctors, a move that industry experts said won't necessarily reduce the quality of care.

Starting this month, nurse practitioner Peter Lapointe moved from Upper Chesapeake Medical Center, where he had worked about 2 1/2 years in the ICU, to Harford Memorial Hospital, where he will cover about 15 evening/night shifts a month, hospital administrators said. Both hospitals are owned by Upper Chesapeake Health.

Harford Memorial had an ICU slot open because a doctor left this year, said Kim Lovett, a spokeswoman for Upper Chesapeake Health.

Although the hospital advertised for a new intensivist, a doctor who specializes in critical or intensive care medicine, and interviewed about a half dozen candidates, it was unable to fill the post, said Antoinette Spevetz, medical director of critical care services at Upper Chesapeake Health.

Lapointe was chosen because the hospital knew him and his work well, Spevetz said.

"We will not hire [a nurse practitioner from outside UCH] into this position because of the level of confidence that we feel we need to have," she said.

Doctors at Harford Memorial have accepted the change, said Peggy Vaughan, senior vice president for medical affairs at the hospital.

Lapointe said his working relationship with the Harford Memorial staff has been good, especially the nursing staff. "The feedback has been excellent," he said.

The hospital said it doesn't expect having a nurse practitioner in the ICU to have a negative effect, especially because an intensivist will remain on call through the nurse's hours, Vaughan said.

Being on call means that a doctor should be able get to the hospital within an hour of being called, she said.

Lapointe said he has called for a second diagnostic opinion over the phone but has not asked the on-call intensivist to come into the ICU.

He also noted that his training as a nurse practitioner, for which he attended graduate school after spending about four years as a registered nurse, focused on critical care.

In school, "I specified I want to be a trauma and critical care nurse practitioner. My entire clinical experience is geared toward that," he said.

That experience was tested on his first night, when a patient in critical condition arrived at the hospital.

"We were able to quickly stabilize a patient who otherwise would have died. We certainly saved her life that night," Lapointe said.

Because of medical privacy regulations, he was unable to give information on that patient's condition after she left the ICU.

The Harford Memorial ICU is much smaller than the ICU at Upper Chesapeake Medical Center, Spevetz said, with six beds to Upper Chesapeake's 22.

"We feel we're providing excellent care," Spevetz said. She added that many area hospitals don't have intensivists 24 hours a day at their ICUs. "We rival the level of care in any university teaching center."

John Eppler, director of the medical/surgical ICU and the cardiac surgery ICU at St. Joseph Medical Center in Towson, said he has some reservations about nurse practitioners, but that situations can vary among hospitals and individuals.

St. Joseph Medical Center has 28 beds and round-the-clock doctor coverage from four house doctors, two of whom are certified in critical care, Eppler said.

"My bias is that doctors have different training than nurses; they have a different point of view and a totally different experience from what nurses have," Eppler said.

"Certainly, you can find people who've had enough experience."

Harford Memorial is "lucky" to have had so much intensivist coverage, said Justine Medina, a registered nurse with the American Association of Critical Care Nurses.

"There are many hospitals, large hospitals, small hospitals who don't have intensivists," Medina said.

She said many hospitals are using nurse practitioners in their ICUs. "There are really good models in which patient care does not suffer if there is clear communication about roles, about expectation," Medina said. "The key thread is the respectful team environment."

The Leapfrog Group, a coalition of public and private organizations that provide health care benefits, recommended in April that hospitals keep an intensivist at the ICU during the day and that an intensivist be able to return pages within five minutes.

Having intensivists in the ICU can help reduce patient mortality, according to a study in the Journal of the American Medical Association.

That study, from the Nov. 6, 2002, issue of the journal, found that having mandatory intensivist consultation for ICU patients could help increase the patient survival rate and decrease patients' length of stay in the ICU.

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