Perspectives on strained intensive care unit capacity: A survey of critical care professionals

Background Strained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain. Methods Cross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management. Results 658 HCW responded (33%; 95% CI, 32 +/- 36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill; while some recommended defining high-quality care, integrating safety, and families in the definition. Participants reported significant contributors to strain were: inability to discharge ICU patients due to lack of available ward beds (97%); increases in the volume (89%); and acuity and complexity of patients requiring ICU support (88%). Strain was perceived to increase stress levels in health care providers (98%); and burnout in health care providers (96%). The highest ranked strategies were: have more consistent and better goals-of-care conversations with patients/families outside of ICU (95%); and increase non-acute care beds (92%). Interpretation Strain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies outside of ICU settings were priorities for managing strain.