Assessment of Need for Lower Level Acuity Critical Care Services at a Tertiary Acute Care Hospital in Canada: a Prospective Cohort Study
CCCF ePoster library. Haun de Oliveira O. Nov 9, 2018; 233418; 106
Dr. Olivia Haun de Oliveira
Dr. Olivia Haun de Oliveira
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Background: In Ontario and in the UK, critically ill patients are categorized by level of acuity, ranging from least acute (level 1) to most acute (level 3).1,2 However, because most critical care beds are classified as either level 2 or level 3, many patients get classified as level 2 when they are actually level 1, creating a high demand for these beds, and long wait times for patients in places such as the emergency department, with the potential for adverse outcomes.3-5 One possible solution is to create level 1 beds to allow lower acuity critically ill patients to be cared for more efficiently in such units. It is unknown how often patients who are assigned to level 2 ICU beds would actually meet the criteria for level 1 care.


Objective: To describe the actual level of care needs for critically ill patients who were assigned to level 2 care at any point during their critical care stay in a tertiary academic hospital in Ontario.


Methods: A prospective cohort study with daily assessment of all critically ill patients at Sunnybrook Health Sciences Centre for their required level of care from April 2nd to May 18th, 2018. All patients identified as receiving level 2 care regardless of their location in the hospital were included (e.g. emergency department). We excluded post cardiac surgery patients treated in the cardiovascular ICU and patients treated in the cardiology ICU for cardiac diseases. The actual requirement for level of care was assessed by both bedside nurse and attending physician. The primary outcome was the proportion of patients who could be triaged to a level 1 bed for the entirety of their critical care stay (see Table 1). Secondary outcomes were (1) the number and proportion of patients who could be triaged to a level 1 unit at some point during the critical care stay and could remain at that level for the rest of their critical care stay; (2) the number and proportion of critical care patient-days that were level 1 care days. Patients were considered level 1 if both bedside nurse and attending physician agreed that this was the appropriate level of care, or if one of them classified the patient as level 1 while the other classified them as ward.


Results: We completed 1354 assessments on 434 patients. Of these assessments, 346 were excluded because patients were identified as requiring level 3 or ward care. We therefore analysed 1,008 assessments on 343 patients. We further excluded 47 patients from assessment of the primary outcome because they were admitted before or discharged after the study period, and therefore we didn’t follow them for the entirety of their stay. Of 296 patients assessed for the primary outcome, 44 (14.9%) could have received care in a level 1 bed for the entirety of their critical care stay. Once classified as requiring level 1 care, 68 (19.8%) patients remained as level 1 for the rest of their critical care stay. A median of 5 (range 2-12) patients per day were classified as level 1 (24.1% of all level 2 patients each day).


Conclusion: In a single centre, 14.9% of patients receiving level 2 critical care could have been cared for in a level 1 bed for the entirety of their critical care stay. A median of 5 patients receiving level 2 care could receive level 1 care each day. We believe this methodology is reproducible in other hospitals to achieve similar local data.

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