Descriptive analysis of critical care units in the United States

Groeger, Jeffrey S.; Strosberg, Martin A.; Halpern, Neil A.; Raphaely, Russell C.; Kaye, William; Guntupalli, Kalpalatha K.; Bertram, D. L.; Greenbaum, Dennis M.; Clemmer, Terry P.; Gallagher, T. James

doi:10.1097/00003246-199206000-00024

Cited by 159 publications

(22 citation statements)

References 1 publication

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“…The 100% response rate obtained in this study is higher than earlier audits completed in the United States, 11,12 but similar to more recent reports. 13 International comparisons of per capita critical care bed numbers demonstrate marked variation in the availability of critical care services.…”

Section: Discussionsupporting

confidence: 89%

“…13 International comparisons of per capita critical care bed numbers demonstrate marked variation in the availability of critical care services. 14 Consistent with this evidence, our data show that Ontario has just over half the number of critical care beds per capita compared to the United States, 11 but almost twice the number reported by the United Kingdom. 14 Clearly, given the costs associated with providing critical care services, there is an inconsistent expenditure across jurisdictions.…”

Section: Discussionsupporting

confidence: 64%

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Critical care services in Ontario: a survey-based assessment of current and future resource needs

Hill

Fan

Stewart

et al. 2009

Can J Anesth/J Can Anesth

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Purpose In response to the challenges of an aging population and decreasing workforce, the provision of critical care services has been a target for quality and efficiency improvement efforts. Reliable data on available critical care resources is a necessary first step in informing these efforts. We sought to describe the availability of critical care resources, forecast the future requirement for the highestlevel critical care beds and to determine the physician management models in critical care units in Ontario, Canada. Methods In June 2006, self-administered questionnaires were mailed to the Chief Executive Officers of all acute care hospitals, identified through the Ontario government's hospital database. The questionnaire solicited information on the number and type of critical care units, number of beds, technological resources and management of each unit.Results Responses were obtained from 174 (100%) hospitals, with 126 (73%) reporting one or more critical care units. We identified 213 critical care units in the province, representing 1789 critical care beds. Over half (59%) of these beds provided mechanical ventilation on a regular basis, representing a capacity of 14.9 critical care and 8.7 mechanically ventilated beds per 100,000 population. Sixty-three percent of units with capacity for mechanical ventilation involved an intensivist in admission and coordination of care. Based on current utilization, the demand for mechanically ventilated beds by 2026 is forecast to increase by 57% over levels available in 2006. Assuming 80% bed utilization, it is estimated that an additional 810 ventilated beds will be needed by 2026. Conclusion Current utilization suggests a substantial increase in the need for the highest-level critical care beds over the next two decades. Our findings also indicate that non-intensivists direct care decisions in a large number of Dr. Sibbald is deceased.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 64%

Critical care services in Ontario: a survey-based assessment of current and future resource needs

Hill

Fan

Stewart

et al. 2009

Can J Anesth/J Can Anesth

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“…9 ICUs can differ significantly in staffing patterns, equipment, and training. 10 It is not known if overflow sepsis patients receive similar care when admitted to non-primary ICUs.…”

Section: Discussionmentioning

confidence: 99%

Does sepsis treatment differ between primary and overflow intensive care units?

Vishnupriya

Falade

Workneh

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Sepsis is a major cause of death in hospitalized patients. Early goal‐directed therapy is the standard of care. When primary intensive care units (ICUs) are full, sepsis patients are cared for in overflow ICUs.OBJECTIVE:To determine if process‐of‐care measures in the care of sepsis patients differed between primary and overflow ICUs at our institution.DESIGN:We conducted a retrospective study of all adult patients admitted with sepsis between July 2009 and February 2010 to either the primary ICU or the overflow ICU.MEASUREMENTS:Baseline patient characteristics and multiple process‐of‐care measures, including diagnostic and therapeutic interventions.RESULTS:There were 141 patients admitted with sepsis to our hospital; 100 were cared for in the primary ICU and 41 in the overflow ICU. Baseline acute physiology and chronic health evaluation (APACHE II) scores were similar. Patients received similar processes‐of‐care in the primary ICU and overflow ICU with the exception of deep vein thrombosis (DVT) and gastrointestinal (GI) prophylaxis within 24 hours of admission, which were better adhered to in the primary ICU (74% vs 49%, P = 0.004, and 68% vs 44%, P = 0.012, respectively). There were no significant differences in hospital and ICU length of stay between the 2 units (9.68 days vs 9.73 days, P = 0.98, and 4.78 days vs 4.92 days, P = 0.97, respectively).CONCLUSIONS:Patients with sepsis admitted to the primary ICU and overflow ICU at our institution were managed similarly. Overflowing sepsis patients to non‐primary intensive care units may not affect guideline‐concordant care delivery or length of stay. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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“…Four domains were investigated: (1) organization of the unit, including intensivist and nursing staffing and availability of support staff; (2) structure of the ICU, including number of hospital and ICU beds, and occupancy rate; (3) academic involvement, including whether residents were assigned to provide any care in the ICU; and (4) patient care with emphasis on processes of care for patients receiving mechanical ventilation. Specific items were adapted from previous surveys on ICU structure and process (25)(26)(27), and additional questions were designed to capture the recommendations formulated by the Society of Critical Care Medicine (15,28) and by the Leapfrog Group (14). Content validity was assessed by having each instrument reviewed by experts in the field and by small groups in each respondent category before the research began, and by using pretests with cognitive debriefing to determine if each question captured the intended domain.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury

Treggiari¹,

Martin²,

Yanez³

et al. 2007

Am J Respir Crit Care Med

124

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Rationale: Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. Objectives: To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). Methods: Cohort study of patients with acute lung injury (ALI). Measurements and Main Results: ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a populationbased cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P 5 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P 5 0.62). These findings were robust for varying assumptions about the study population definition. Conclusions: Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.

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Descriptive analysis of critical care units in the United States

Cited by 159 publications

References 1 publication

Critical care services in Ontario: a survey-based assessment of current and future resource needs

Critical care services in Ontario: a survey-based assessment of current and future resource needs

Does sepsis treatment differ between primary and overflow intensive care units?

Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury

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