title: Comprehensive assessment of critical care needs in a community hospital*.
abstract: OBJECTIVE
  To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital.
  
  
  METHODS
  This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13).
  
  
  METHODS
  None.
  
  
  RESULTS
  Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions.
  
  
  CONCLUSIONS
  This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.
authors.affiliation: 1Division of Critical Care, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 2The Academy for Innovation in Medical Education (AIME), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 3Practice, Performance and Innovation (PPI) Unit, The Royal College of Physicians and Surgeons of Canada (RCPSC), Ottawa, ON, Canada. 4School of Nursing, The University of Ottawa, Ottawa, ON, Canada. 5University of Ottawa Skills and Simulation Centre (uOSSC), Ottawa, ON, Canada.
authors.forename: Aimee J
authors.initials: AJ
authors.lastname: Sarti
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sutherland
authors.forename: Angèle
authors.initials: A
authors.lastname: Landriault
authors.forename: Frances
authors.initials: F
authors.lastname: Fothergill-Bourbonnais
authors.forename: Redouane
authors.initials: R
authors.lastname: Bouali
authors.forename: Timothy
authors.initials: T
authors.lastname: Willett
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Hamstra
authors.forename: Pierre
authors.initials: P
authors.lastname: Cardinal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003422:Critical Care / Q000458:organization & administration*; D005190:Family; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units / Q000458:organization & administration*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010348:Patient Care Team / Q000458:organization & administration; D010465:Perception; D011787:Quality of Health Care / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration; D057188:Workflow