Sources and Impact of Strain on Intensive Care Unit Capacity: a Survey of Critical Care Providers
CCCF ePoster library. Opgenorth D. Oct 31, 2016; 150924; 44
Dawn Opgenorth
Dawn Opgenorth
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Topic: Survey or Interview (quantitative or qualitative)

Sources and Impact of Strain on Intensive Care Unit Capacity: a Survey of Critical Care Providers


Opgenorth, Dawn1,; Stelfox, Henry T.2,3,4; Gilfoyle, Elaine5; Gibney, R.T. Noel1; Meier, Michael1; Boucher, Paul2; Wickson, Patty4; McKinlay, David1; Zygun, David A.1,4; Bagshaw, Sean M.1,4
 
1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
2. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
4. Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
5. Section of Critical Care, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Grant acknowledgements:
Funded by a Partnership for Research and Innovation in the Health System (PRIHS) grant from Alberta Innovates – Health Solutions.

Abstract:

Introduction: Mismatch in the supply and demand relationship for critical care services can precipitate strain on intensive care unit (ICU) capacity. Strain may compromise quality of care, contribute to inefficient resource utilization and precipitate a negative workplace environment. Previously, we performed a series of inter-professional focus groups of ICU providers to identify major themes related to strained ICU capacity.
 
Objective: To survey inter-professional ICU health care providers (HCP) on their perceptions of contributors to, impact of and strategies to manage strained ICU capacity across Alberta.
 
Methods: A unique web-based 70-item questionnaire was developed. The sampling frame were ICU HCPs from 16 general medical, cardiac surgical and neuroscience ICUs in Alberta. The survey was conducted between March 21 - May 20, 2016. The questionnaire captured socio-demographic data (6 questions) and utilized a 5-point Likert Scale (1 – Strongly Disagree to 5 – Strongly Agree) with additional open-ended questions for comment, focused on defining strain (2 questions), sources of strain (18 questions), impact of strain (14 questions) and potential strategies (30 questions). The questionnaire was pre-tested, evaluated for clinical sensibility and pilot tested prior to implementation. Data analysis was descriptive.
 
Results: Six hundred fifty-nine HCPs completed the survey, including 429 (65.1%) registered nurses (RN), nurse practitioners (NP), 92 (13.9%) registered respiratory therapists (RT), 45 (6.8%) attending physicians, 20 (3.0%) administrators/managers and 73 (11.1%) allied health and other professionals. The majority were aged 26-50 years (507 [77.1%]) and had worked in ICU for >5 years (376 [57.1%]). In total, 94.1% of respondents agreed/strongly agreed capacity strain was defined 'as a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provided needed high-quality care for patients who may become or who are critically ill'. The most important contributors to strain were perceived as: inability to discharge ICU patients (97.3% of respondents), increased demand for ICU services (i.e., more critically ill patients [88.6%]), increased patient complexity/acuity (88.0%) and inadequate numbers of bedside nurses to cover workload (78.5%). Strained capacity was perceived to contribute to increased provider stress (98.4%), burnout (96.1%), a negative workplace environment (95.5%), excess workload (94.9%) and reduced quality of care (93.4%). Strategies perceived by respondents to potentially manage strain included: more consistent/better quality goals-of-care discussions prior to ICU (95.1%), increases in the number of non-acute care beds (i.e., long-term care) (92.5%) and development of greater capacity for intermediate (i.e., stepdown) care beds (90.5%).
 
Conclusions: Strained capacity is perceived to be common among inter-professional ICU providers. Most suggest the precipitants represent a mixture of patient-specific and operational factors (i.e., patient flow). Strain is strongly believed to have negative implications for quality of care, provider well-being and workplace health. Most indicated strategies 'outside' of direct ICU settings as priorities for managing strain. These findings should help prioritize and direct future initiatives aimed at managing strained capacity in ICUs across Alberta


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