A unique and increasingly important component of the critical care team is the ICU physician extender group (nurse practitioners & physician assistants).  Currently, there are 8 members who cover our Cardio-thoracic & vascular ICU. This group is specifically trained to manage acute clinical situations, assist and coordinate the triage and transfers of patients into and out of the ICU, and help manage the various protocols in the ICU, especially for highly specialized patient groups such as transplants, mechanical assist devices etc. Most of the nurse practitioners are former ICU nurses and the entire group is a vital addition to the layered approach to critical care we have created. These providers help ensure efficient coordination of consultations, specialized tests/procedures and other protocols 24/7, including full night coverage.