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Crit Care. 2018 Mar 27;22(1):86. doi: 10.1186/s13054-018-1975-3.

Indicators of intensive care unit capacity strain: a systematic review.

Author information

1
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440 - 112th Street, Edmonton, AB, T6G 2B7, Canada. rewa@ualberta.ca.
2
School of Public Health, University of Alberta, Edmonton, AB, Canada. rewa@ualberta.ca.
3
Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
4
Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
5
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
6
O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
7
Alberta School of Business, University of Alberta, Edmonton, AB, Canada.
8
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440 - 112th Street, Edmonton, AB, T6G 2B7, Canada.
9
School of Public Health, University of Alberta, Edmonton, AB, Canada.
10
Alberta Research Center for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Abstract

BACKGROUND:

Strained intensive care unit (ICU) capacity represents a fundamental supply-demand mismatch in ICU resources. Strain is likely to be influenced by a range of factors; however, there has been no systematic evaluation of the spectrum of measures that may indicate strain on ICU capacity.

METHODS:

We performed a systematic review to identify indicators of strained capacity. A comprehensive peer-reviewed search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection was performed along with selected grey literature sources. We included studies published in English after 1990. We included studies that: (1) focused on ICU settings; (2) included description of a quality or performance measure; and (3) described strained capacity. Retrieved studies were screened, selected and extracted in duplicate. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was descriptive.

RESULTS:

Of 5297 studies identified in our search; 51 fulfilled eligibility. Most were cohort studies (n = 39; 76.5%), five (9.8%) were case-control, three (5.8%) were cross-sectional, two (3.9%) were modeling studies, one (2%) was a correlational study, and one (2%) was a quality improvement project. Most observational studies were high quality. Sixteen measures designed to indicate strain were identified 110 times, and classified as structure (n = 4, 25%), process (n = 7, 44%) and outcome (n = 5, 31%) indicators, respectively. The most commonly identified indicators of strain were ICU acuity (n = 21; 19.1% [process]), ICU readmission (n = 18; 16.4% [outcome]), after-hours discharge (n = 15; 13.6% [process]) and ICU census (n = 13; 11.8% [structure]). There was substantial heterogeneity in the operational definitions used to define strain indicators across studies.

CONCLUSIONS:

We identified and characterized 16 indicators of strained ICU capacity across the spectrum of healthcare quality domains. Future work should aim to evaluate their implementation into practice and assess their value for evaluating strategies to mitigate strain.

SYSTEMATIC REVIEW REGISTRATION:

This systematic review was registered at PROSPERO (March 27, 2015; CRD42015017931 ).

KEYWORDS:

Adverse event; Capacity; Indicator; Intensive care unit; Organization; Performance; Quality; Safety; Strain

PMID:
29587816
PMCID:
PMC5870068
DOI:
10.1186/s13054-018-1975-3
[Indexed for MEDLINE]
Free PMC Article

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