title: Healthcare Provider Perceptions of Causes and Consequences of ICU Capacity Strain in a Large Publicly Funded Integrated Health Region: A Qualitative Study.
abstract: OBJECTIVE
  Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain.
  
  
  METHODS
  Qualitative study using a conventional thematic analysis.
  
  
  METHODS
  Nine ICUs across Alberta, Canada.
  
  
  METHODS
  Nineteen focus groups (n = 122 participants).
  
  
  METHODS
  None.
  
  
  RESULTS
  Participants' perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined "capacity strain" as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were "increasing patient complexity/acuity," along with patient-provider communication issues ("paucity of advance care planning and goals-of-care designation," "mismatches between patient/family and provider expectations," and "timeliness of end-of-life care planning"). Provider-related factor subthemes were nursing workforce related ("nurse attrition," "inexperienced workforce," "limited mentoring opportunities," and "high patient-to-nurse ratios") and physician related ("frequent turnover/handover" and "variations in care plan"). Resource-related subthemes were "reduced service capability after hours" and "physical bed shortages." Health system-related subthemes were "variable ICU utilization," "preferential "bed" priority for other services," and "high ward bed occupancy." Participants perceived that strain had negative implications for patients ("reduced quality and safety of care" and "disrupted opportunities for patient- and family-centered care"), providers ("increased workload," "moral distress," and "burnout"), and the health system ("unnecessary, excessive, and inefficient resource utilization").
  
  
  CONCLUSIONS
  Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.
authors.affiliation: 1Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.2Department of Critical Care Medicine, Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.3Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.5Workforce Research and Evaluation, Alberta Health Services, Calgary, AB, Canada.6Section of Critical Care, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.7Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Dawn
authors.initials: D
authors.lastname: Opgenorth
authors.forename: Melissa
authors.initials: M
authors.lastname: Potestio
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Hastings
authors.forename: Shelanne L
authors.initials: SL
authors.lastname: Hepp
authors.forename: Elaine
authors.initials: E
authors.lastname: Gilfoyle
authors.forename: David
authors.initials: D
authors.lastname: McKinlay
authors.forename: Paul
authors.initials: P
authors.lastname: Boucher
authors.forename: Michael
authors.initials: M
authors.lastname: Meier
authors.forename: Jeanna
authors.initials: J
authors.lastname: Parsons-Leigh
authors.forename: R T Noel
authors.initials: RT
authors.lastname: Gibney
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D032722:Advance Care Planning; D039602:After-Hours Care; D000416:Alberta; D001291:Attitude of Health Personnel; D001509:Bed Occupancy; D002055:Burnout, Professional / Q000209:etiology; D003142:Communication; D017144:Focus Groups; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D009740:Nursing Staff / Q000458:organization & administration / Q000600:supply & distribution*; D062072:Patient Acuity; D010465:Perception; D010563:Personnel Turnover; D010817:Physician-Patient Relations; D010820:Physicians / Q000458:organization & administration / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D036301:Qualitative Research; D011787:Quality of Health Care; D013222:State Medicine; D016526:Workload