title: Quality and performance measures of strain on intensive care capacity: a protocol for a systematic review.
abstract: BACKGROUND
  The matching of critical care service supply with demand is fundamental for the efficient delivery of advanced life support to patients in urgent need. Mismatch in this supply/demand relationship contributes to "intensive care unit (ICU) capacity strain," defined as a time-varying disruption in the ability of an ICU to provide well-timed and high-quality intensive care support to any and all patients who are or may become critically ill. ICU capacity strain leads to suboptimal quality of care and may directly contribute to heightened risk of adverse events, premature discharges, unplanned readmissions, and avoidable death. Unrelenting strain on ICU capacity contributes to inefficient health resource utilization and may negatively impact the satisfaction of patients, their families, and frontline providers. It is unknown how to optimally quantify the instantaneous and temporal "stress" an ICU experiences due to capacity strain.
  
  
  METHODS
  We will perform a systematic review to identify, appraise, and evaluate quality and performance measures of strain on ICU capacity and their association with relevant patient-centered, ICU-level, and health system-level outcomes. Electronic databases (i.e., MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and the Agency of Healthcare Research and Quality (AHRQ) - National Quality Measures Clearinghouse (NQMC)) will be searched for original studies of measures of ICU capacity strain. Selected gray literature sources will be searched. Search themes will focus on intensive care, quality, operations management, and capacity. Analysis will be primarily narrative. Each identified measure will be defined, characterized, and evaluated using the criteria proposed by the US Strategic Framework Board for a National Quality Measurement and Reporting System (i.e., importance, scientific acceptability, usability, feasibility).
  
  
  CONCLUSIONS
  Our systematic review will comprehensively identify, define, and evaluate quality and performance measures of ICU capacity strain. This is a necessary step towards understanding the impact of capacity strain on quality and performance in intensive care and to develop innovative interventions aimed to improve efficiency, avoid waste, and better anticipate impending capacity shortfalls.
  
  
  BACKGROUND
  PROSPERO, CRD42015017931.
authors.affiliation: Alberta School of Business, University of Alberta, Edmonton, Canada. soltani@ualberta.ca.
authors.forename: S Abolfazi
authors.initials: SA
authors.lastname: Soltani
authors.affiliation: Alberta School of Business, University of Alberta, Edmonton, Canada. aingolfs@ualberta.ca.
authors.forename: Armann
authors.initials: A
authors.lastname: Ingolfsson
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112th Street, Edmonton, Alberta, T6G 2B7, Canada. zygun@ualberta.ca.|Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada. zygun@ualberta.ca.
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.affiliation: Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada. tstelfox@ucalgary.ca.|Department of Critical Care Medicine, University of Calgary, Calgary, Canada. tstelfox@ucalgary.ca.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada. hartling@ualberta.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.affiliation: Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada. feathers@ualberta.ca.
authors.forename: Robin
authors.initials: R
authors.lastname: Featherstone
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112th Street, Edmonton, Alberta, T6G 2B7, Canada. dawno@ualberta.ca.|Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada. dawno@ualberta.ca.
authors.forename: Dawn
authors.initials: D
authors.lastname: Opgenorth
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112th Street, Edmonton, Alberta, T6G 2B7, Canada. bagshaw@ualberta.ca.|Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Canada. bagshaw@ualberta.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D003422:Critical Care / Q000592:standards*; D016638:Critical Illness; D006301:Health Services Needs and Demand; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D012107:Research Design; D000078202:Systematic Reviews as Topic