Health Care Provider Perceptions of Sources and Impact of Strain on Intensive Care Unit Capacity: A Qualitative Study
CCCF ePoster library. Opgenorth D. Oct 28, 2015; 117308; P103 Disclosure(s): Partnership for Research and Innovation in the Health System (PRIHS), Alberta Innovates – Health Solutions.
Dawn Opgenorth
Dawn Opgenorth
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Abstract
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P103


Topic: Survey (quantitative or qualitative)


Health Care Provider Perceptions of Sources and Impact of Strain on Intensive Care Unit Capacity: A Qualitative Study



Dawn Opgenorth, H. Stelfox, M. Potestio, P. Wickson, D. Zygun, E. Gilfoyle, R. Gibney, M. Meier, P. Boucher, D. McKinlay, S. Bagshaw

Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada | Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Canada | Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, University of Calgary, Calgary, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

Introduction: A mismatch in the supply and demand relationship for critical care services precipitates a strain on intensive care unit (ICU) capacity. Capacity strain can lead to the delivery of suboptimal quality of care and worse outcomes for patients, burnout among providers and directly contribute to inefficient utilization of health resources.

Objectives: To explore the perceptions of inter-professional health care providers on the sources and impact of ICU capacity strain.

Methods: Qualitative study using focus groups representing eight ICUs across Alberta. Sixty-five participants comprised of registered nurses (n=49); registered respiratory therapists (n=11); and allied health providers (n=5). Participants’ experiences and perspectives on strain on ICU capacity, and its perceived impact on health care providers, families and patient care were explored using conventional content analysis.

Results: Participants defined “capacity strain” as an imbalance between the availability of ICU beds, providers and critical care resources (supply) and the need to admit and provide care for new critically ill patients (demand). Participants grouped the sources of capacity strain across four inter-related themes (each with subthemes): 1) patient/family-related; 2) provider-related; 3) resource-related; and 4) health system-related. Participants perceived that four subthemes related to patient/family-related factors contributed to capacity strain: i) recent increases in patient acuity; with the other three related to patient-provider communication, ii) paucity of advance care planning and goals of care designation; iii) mismatches between patient/family and provider expectations; and iv) timeliness of end-of-life care planning. Participants perceived six provider-related factors contribute to capacity strain: four nursing workforce-related subthemes (i) increased nursing attrition; ii) large inexperienced nursing workforce; iii) limited opportunities to prepare and mentor junior nurses; and iv) low nurse to patient ratios in the context of increases in patient acuity); and two physician-related subthemes (v) constant rotation turnover; and vi) variations in care plan). Participants identified three resource-related subthemes: i) reduced service capability at nighttime/weekends; ii) inadequate/outdated equipment and physical space; and iii) physical bed shortages. Three subthemes related to the health system were identified: i) variation in ICU admission policies and criteria; ii) preferential “bed” priority given to the emergency department (exit block); and iii) high ward bed occupancy (exit block)). Participants believed capacity strain has negative implications for patients (by reducing the quality and safety of care; and impairing opportunities to support patients’ families); health care providers (by increasing workload; and predisposing to moral distress and burnout); and the health system in general (by unnecessary, excessive and inefficient resource utilization). Participants presented suggestions for improvement across the identified themes and subthemes including: better communication to establish goals of care prior to critical illness and regarding end-of-life care; establishing consistent ICU admission policies and criteria; expanding provider support (i.e., hiring, advanced training, mentoring); better utilization of regional critical care units; and expansion of both critical care and non-critical care bed capacity (i.e., long-term care).

Conclusion: Health care providers described core themes and subthemes contributing to capacity strain, its perceived impact across the health care system, along with multi-faceted strategies for improvement. Engagement with frontline health care providers is essential for understanding their experiences and perspectives of capacity strain and developing sustainable strategies for improvement.

References: None.
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