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Critical care services in Ontario: a survey-based assessment of current and future resource needs |
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| Authors: | Andrea D Hill MSc Eddy Fan MD Thomas E Stewart MD William J Sibbald MD Eric Nauenberg PhD Bernard Lawless MD Jocelyn Bennett RN Claudio M Martin MD |
| Institution: | 1. University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11C-1165, Toronto, ON, Canada, M5G 2C4 2. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada 3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA 4. Mount Sinai Hospital, Toronto, ON, Canada 5. Sunnybrook Health Sciences Centre, Toronto, ON, Canada 6. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada 7. Department of Surgery, University of Toronto, Toronto, ON, Canada 8. Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Centre and the University of Western Ontario, London, ON, Canada |
| Abstract: | PurposeIn response to the challenges of an aging population and decreasing workforce, the provision of critical care services has been a target for quality and efficiency improvement efforts. Reliable data on available critical care resources is a necessary first step in informing these efforts. We sought to describe the availability of critical care resources, forecast the future requirement for the highest-level critical care beds and to determine the physician management models in critical care units in Ontario, Canada.MethodsIn June 2006, self-administered questionnaires were mailed to the Chief Executive Officers of all acute care hospitals, identified through the Ontario government’s hospital database. The questionnaire solicited information on the number and type of critical care units, number of beds, technological resources and management of each unit.ResultsResponses were obtained from 174 (100%) hospitals, with 126 (73%) reporting one or more critical care units. We identified 213 critical care units in the province, representing 1789 critical care beds. Over half (59%) of these beds provided mechanical ventilation on a regular basis, representing a capacity of 14.9 critical care and 8.7 mechanically ventilated beds per 100,000 population. Sixty-three percent of units with capacity for mechanical ventilation involved an intensivist in admission and coordination of care. Based on current utilization, the demand for mechanically ventilated beds by 2026 is forecast to increase by 57% over levels available in 2006. Assuming 80% bed utilization, it is estimated that an additional 810 ventilated beds will be needed by 2026.ConclusionCurrent utilization suggests a substantial increase in the need for the highest-level critical care beds over the next two decades. Our findings also indicate that non-intensivists direct care decisions in a large number of responding units. Unless major investments are made, significant improvements in efficiency will be required to maintain future access to these services. |
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