title: Intensive care in critical access hospitals.
abstract: BACKGROUND
  Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services.
  
  
  OBJECTIVE
  To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
  
  
  METHODS
  A semistructured interview of directors of nursing at CAHs that provide intensive care services.
  
  
  RESULTS
  Two thirds of CAHs that provide intensive care do so in a distinct unit. Most have continuous or computerized electrocardiography and ventilators. Other ICU equipment common in larger hospitals was reported less frequently. Nurse:patient ratio ranged from 1:1 to 1:3, and some or all nursing staff have advanced cardiac life support certification. Most CAHs admit patients to the ICU daily or weekly, primarily treating cardiac, respiratory, gastrointestinal, endocrine, and drug- or alcohol-related conditions. ICUs are also used for postsurgical recovery. Respondents felt that closure of the ICU would be burdensome to patients and families, result in lost revenue, negatively impact staff, and affect the community's perception of the hospital.
  
  
  CONCLUSIONS
  Intensive care services provided by CAHs fall along a continuum, ranging from care in a unit that resembles a scaled-down version of ICUs in larger hospitals to care in closely monitored medical-surgical beds. Nurse to patient ratio, not technology, is arguably the defining characteristic of intensive care in CAHs. Respondents believe these services to be important to the well-being of the hospital and of the community.
authors.affiliation: North Carolina Rural Health Research and Policy Analysis Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. freeman@mail.schsr.unc.edu
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Freeman
authors.forename: Joan
authors.initials: J
authors.lastname: Walsh
authors.forename: Matthew
authors.initials: M
authors.lastname: Rudolf
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Slifkin
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
mesh_terms: D000208:Acute Disease; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006271:Health Facility Closure; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D007902:Length of Stay; D010360:Patient Transfer; D014481:United States