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. 2018 Aug 22;13(8):e0201524.
doi: 10.1371/journal.pone.0201524. eCollection 2018.

Perspectives on strained intensive care unit capacity: A survey of critical care professionals

Dawn Opgenorth  1 , Henry T Stelfox  2   3   4 , Elaine Gilfoyle  3   5 , R T Noel Gibney  1 , Michael Meier  1   3 , Paul Boucher  2   3 , David McKinlay  1 , Christiane N Job McIntosh  3 , Xiaoming Wang  6 , David A Zygun  1   3 , Sean M Bagshaw  1   3
Affiliations

Perspectives on strained intensive care unit capacity: A survey of critical care professionals

Dawn Opgenorth et al. PLoS One. .

Abstract

Background: Strained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain.

Methods: Cross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management.

Results: 658 HCW responded (33%; 95%CI, 32-36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as "a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill"; while some recommended defining "high-quality care", integrating "safety", and families in the definition. Participants reported significant contributors to strain were: "inability to discharge ICU patients due to lack of available ward beds" (97%); "increases in the volume" (89%); and "acuity and complexity of patients requiring ICU support" (88%). Strain was perceived to "increase stress levels in health care providers" (98%); and "burnout in health care providers" (96%). The highest ranked strategies were: "have more consistent and better goals-of-care conversations with patients/families outside of ICU" (95%); and "increase non-acute care beds" (92%).

Interpretation: Strain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies "outside" of ICU settings were priorities for managing strain.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Summary of participant perceptions of contributors to strained ICU capacity.
Fig 2
Fig 2. Summary of participant perceptions of the impact of strained ICU capacity.
Fig 3
Fig 3. Summary of participant perceptions of strategies to mitigate and manage strained ICU capacity.
Fig 4
Fig 4. Ranking of participant perceptions of the most effective strategies to potentially mitigate and manage strained ICU capacity.
Fig 5
Fig 5. Summary of the proportion of time health care workers perceived their ICU is strained due to capacity issues.
See this image and copyright information in PMC

References

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