Review of a Large Clinical Series: Structure,Process,and Outcome of all Intensive Care Units Within the Province of British Columbia,Canada

Abstract

Purpose: To describe the total and regional capacity for critical care in British Columbia (BC), Canada, and to describe regional variation in number of intensive care units (ICUs), size of ICUs, length of ICU stay, ICU occupancy, key processes of critical care, and hospital mortality for ICU patients in B.C. Methods: In this cross-sectional study, we used retrospectively collected data from all patients admitted to an ICU in BC between April1, 1998, and March 31, 1999, and responses to a survey about organizational factors for all ICUs in BC that was done in 2001 and updated in 2008. Results: The number of ICU beds in each geographic region in BC is inversely related to the population density and population growth within those regions. In addition, the distribution of ICU beds does not match the distribution of specialized and high-risk clinical services. There is wide variation by geographic region and by size of ICU in physician and nurse staffing, physician model of care, availability and participation of respiratory therapists, and other support services in clinical care and in reported use of clinical practice guidelines. Conclusion: Variation and lack of availability of key processes for care of critically ill patients in this population identifies opportunities for knowledge translation and systematic improvement including regionalization of care.

Keywords

intensive care unit models organizational

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