Perspectives on strained intensive care unit capacity: A survey of critical care professionals

Abstract

BackgroundStrained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain.MethodsCross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management.Results658 HCW responded (33%; 95%CI, 32–36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as “a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill”; while some recommended defining “high-quality care”, integrating “safety”, and families in the definition. Participants reported significant contributors to strain were: “inability to discharge ICU patients due to lack of available ward beds” (97%); “increases in the volume” (89%); and “acuity and complexity of patients requiring ICU support” (88%). Strain was perceived to “increase stress levels in health care providers” (98%); and “burnout in health care providers” (96%). The highest ranked strategies were: “have more consistent and better goals-of-care conversations with patients/families outside of ICU” (95%); and “increase non-acute care beds” (92%).InterpretationStrain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies “outside” of ICU settings were priorities for managing strain.

Association Between Intensive Care Unit Occupancy at Discharge, Afterhours Discharges, & Clinical Outcomes: An Historical Cohort Study

“…Perhaps, the combination of our flexible ICU capacity, Critical Care Outreach Team, and HAU services provides the structural support to mitigate the clinical consequences of capacity strain. It is well known and understandable that ICU physicians and staff experience increased stress during periods of increased capacity strain (29)(30)(31). Our study does validate that capacity strain, such as high occupancy, modifies the discharge process by increasing the amount of afterhours discharges.…”

Incremental costs of high intensive care utilisation in patients hospitalised with heart failure

“…In addition, efforts to redirect patients with HF who do not require intensive care therapies or monitoring to regular hospital ward beds may improve ICU capacity strain without an undue impact on survival. 19,20 The development of more judicious and evidence-based ICU admission criteria that focus on reducing low acuity admissions and better aligning hospital resources with patient care needs can potentially reduce hospital care costs. Previous studies in general intensive care have estimated that 69% of all admissions were low acuity and accounted for one quarter of total costs.…”

“…In addition, efforts to redirect patients with HF who do not require intensive care therapies or monitoring to regular hospital ward beds may improve ICU capacity strain without an undue impact on survival. 19,20…”

Physicians’ Perceptions of Stakeholder Influence on Discharge Timing in a Children’s Hospital

“…Inhibited patient flow through general wards beds has negative effects on ICU patients from a patient safety perspective and on ICU providers from a stress and resource allocation perspective. 18…”