Care in Canadian Intensive Care Units
CCCF ePoster library. Fagbemi J. Oct 31, 2016; 150920; 41
Josh Fagbemi
Josh Fagbemi
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Abstract
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#41

Topic: Quality Assurance & Improvement

Care in Canadian Intensive Care Units


Fagbemi, Josh1
1 Canadian Institute for Health Information, Toronto, Ontario, Canada



Abstract:

Introduction
Canada’s aging population and end of life challenges are contributing to concerns around costs, sustainability and performance of ICUs. And while individual facility ICU data is often available, comprehensive, cross-jurisdictional reporting of ICU information is lacking. Availability of comparable data on ICUs can help inform system, hospital and ICU-level initiatives to enhance performance and ensure appropriate critical care capacity. It can also inform improvement initiatives on patient care and outcomes. The Canadian Institute for Health Information’s role (CIHI) in data collection and standards allows it to provide pan-Canadian data on intensive care.
Objectives
This study provides high-level information on ICU capacity, trends in overall use and admissions, patient populations, processes of care, and specific patient care measures. These baseline and comparable measures of ICU care will be useful in facilitating future comparative reporting in this area. Together, they provide more information on ICU operations in general to better understand the use of this constrained resource with respect to operating patterns and patient flows that could assist with monitoring of ICU performance and quality of care over time.
Methods
Using data from CIHI’s Discharge Abstract Database (DAD), this study is focused on patients from general and specialized ICUs based on abstracts for patients aged 18 and older at the time of ICU admission. It excludes admissions to neonatal and paediatric ICUs. Study development is informed by literature and review of critical care measurement and reporting across Canada, as well as through consultations with experts.
Results
Use of ICUs in Canada is increasing faster than acute care hospitalizations overall. In 2013-14, 11% of just over 2 million hospitalizations in Canada, excluding Quebec, involved ICU stays. This corresponds to over 230,800 adult ICU admissions, an increase of 13% since 2007-08. During the same time frame, adult hospital admissions increased by 7%.
8 in 10 ICU admissions resulted from urgent hospital admissions, with variation across jurisdictions. This has implications for patient outcomes, resource utilization and capacity planning.
Most ICU beds are in large or teaching hospitals, where having enough ICU beds to meet the growing demand is a widespread challenge. On average, large and teaching hospital ICUs operate at about 90% capacity, with periods over capacity for the equivalent of between 45 and 51 days in 2013-14.
Invasive ventilation is one of the most common processes of care in ICU, received by 34% of ICU patients in 2013-14, up from 29% in 2007-08. The biggest increase was among those who received short term invasive ventilation (i.e. ≤96 hours). The continued rise in use for ventilation will likely place additional strain on ICUs due to expected increasing severity of illness and population aging.
Conclusion
ICU capacity is a health system challenge in Canada and increasing demand for critical care is expected to continue to rise. This study can help inform evidence-based system improvement efforts by providing baseline measures of ICU care in Canada at national, provincial, and facility levels. It can also serve as a resource for discussions relating to development, reporting and monitoring of comparable capacity and quality of care indicators and benchmarks to inform patient care decisions, and facilitate best-practice discussions across jurisdictions.


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