Physician Perceptions of Sources and Impact of Strain on Intensive Care Unit Capacity: A Qualitative Study
CCCF ePoster library. Bagshaw S. Oct 28, 2015; 117313; P102 Disclosure(s): Partnership for Research and Innovation in the Health System (PRIHS), Alberta Innovates – Health Solutions
Dr. Sean M Bagshaw
Dr. Sean M Bagshaw
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Abstract
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P102


Topic: Survey (quantitative or qualitative)


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



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

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

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 jeopardize patient care, contribute to reduced job satisfaction among physicians, and inefficiently consume finite critical care health resources.

Objectives: To explore the perceptions of critical care physicians on the sources and impact of ICU capacity strain.

Methods: Qualitative study using focus groups representing 34 physicians from 7 ICUs across Alberta. Physicians’ experiences and perspectives on ICU capacity strain, its perceived impact on physicians, inter-professional health care providers, and patients/families and strategies to mitigate strain were explored using conventional content analysis.

Results:

Physicians agreed that 'capacity strain” was defined as a discrepancy between the availability of ICU beds, health care providers, and critical care resources such as ventilators (supply) and the necessity to admit and provide care for patients with life threatening critical illness (demand). Physicians believed that capturing measures in 'real time' to anticipate strain remains inadequate. Physicians grouped the sources of capacity strain across four inter-related themes (each with subthemes): patient/family-related; provider-related; resource-related; and health system-related. Physicians perceived that three patient/family-related subthemes contributed to capacity strain: significant recent increases in patient acuity and complexity; mismatch between patient/family and provider expectations; and excessive provision of non-beneficial treatments. Physicians perceived three provider-related factors contributed to capacity strain: nursing inexperience in caring for critically ill patients (i.e., recent graduates or new staff); nursing workforce shortages; and resident/bedside provider inexperience in managing critically ill patients. Physicians identified three resource-related subthemes: inadequate number of beds, physical space and equipment (i.e., mechanical ventilator; dialysis); inadequate availability of inter-professional providers (i.e., rehabilitation; social work); and delays in bed turnover due to operations logistics (i.e., room cleaning). Three subthemes related to the health system were identified: inadequate triage, inequitable utilization, and delayed real-time communication of available or strained regional critical care resources; high ward bed occupancy (exit block); and limited understanding by society of issues pertaining to end-of-life care and ICU support. Physicians believed capacity strain has negative implications for patients (by reducing the quality and safety of care; and impairing timely conferences with families to discuss care plan); and health care providers (by increasing workload not directed at patient care; and predisposing to reduced job satisfaction). Physicians presented several proposals for improvement across the identified themes and subthemes including: introduce a dedicated ICU capacity/patient flow/bed manager; develop a 'capacity strain standard operating care pathway'; introduce greater flexibility to respond to strain in capacity (i.e., bed and provider availability); introduce alternative provider resources (i.e., advanced nurse practitioner; physician assistants); implement measures to minimize unnecessary physician distractions; improve engagement with patients/families regarding end-of-life care; improve regional utilization of critical care services; expansion of both critical care and non-critical care bed capacity (i.e., long-term care).



Conclusion: Physicians described core themes and subthemes contributing to capacity strain, its perceived impact across the health care system, along with proposals for improvement. Engagement with bedside critical care physicians is a necessity for understanding their viewpoints of capacity strain and for developing sustainable strategies for improvement.

References: None.
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