Hill Andrea D, Fan Eddy, Stewart Thomas E, Sibbald William J, Nauenberg Eric, Lawless Bernard, Bennett Jocelyn, Martin Claudio M
University Health Network, Toronto General Hospital, and Department of Health Policy Management and Evaluation, University of Toronto, 200 Elizabeth Street, 11C-1165, Toronto, ON, Canada, M5G 2C4.
Can J Anaesth. 2009 Apr;56(4):291-7. doi: 10.1007/s12630-009-9055-4. Epub 2009 Feb 21.
In response to the challenges of an aging population and decreasing workforce, the provision of critical care services has been a target for quality and efficiency improvement efforts. Reliable data on available critical care resources is a necessary first step in informing these efforts. We sought to describe the availability of critical care resources, forecast the future requirement for the highest-level critical care beds and to determine the physician management models in critical care units in Ontario, Canada.
In June 2006, self-administered questionnaires were mailed to the Chief Executive Officers of all acute care hospitals, identified through the Ontario government's hospital database. The questionnaire solicited information on the number and type of critical care units, number of beds, technological resources and management of each unit.
Responses were obtained from 174 (100%) hospitals, with 126 (73%) reporting one or more critical care units. We identified 213 critical care units in the province, representing 1789 critical care beds. Over half (59%) of these beds provided mechanical ventilation on a regular basis, representing a capacity of 14.9 critical care and 8.7 mechanically ventilated beds per 100,000 population. Sixty-three percent of units with capacity for mechanical ventilation involved an intensivist in admission and coordination of care. Based on current utilization, the demand for mechanically ventilated beds by 2026 is forecast to increase by 57% over levels available in 2006. Assuming 80% bed utilization, it is estimated that an additional 810 ventilated beds will be needed by 2026.
Current utilization suggests a substantial increase in the need for the highest-level critical care beds over the next two decades. Our findings also indicate that non-intensivists direct care decisions in a large number of responding units. Unless major investments are made, significant improvements in efficiency will be required to maintain future access to these services.
为应对人口老龄化和劳动力减少的挑战，重症监护服务的提供一直是质量和效率提升工作的目标。有关可用重症监护资源的可靠数据是开展这些工作的必要第一步。我们试图描述安大略省重症监护资源的可用性，预测对最高级别的重症监护病床的未来需求，并确定加拿大安大略省重症监护病房的医生管理模式。
2006年6月，通过安大略省政府的医院数据库确定了所有急症护理医院的首席执行官，并向他们邮寄了自填式问卷。该问卷征集了有关重症监护病房的数量和类型、床位数、技术资源以及每个病房管理情况的信息。
收到了174家（100%）医院的回复，其中126家（73%）报告有一个或多个重症监护病房。我们在该省确定了213个重症监护病房，共有1789张重症监护病床。其中超过一半（59%）的病床定期提供机械通气服务，这意味着每10万人口中有14.9张重症监护病床和8.7张提供机械通气的病床。63%能够进行机械通气的病房在患者入院和护理协调方面有重症监护专科医生参与。根据目前的使用情况，预计到2026年，对机械通气病床的需求将比2006年的可用水平增加57%。假设床位利用率为80%，预计到2026年将额外需要810张带机械通气功能的病床。
目前的使用情况表明，在未来二十年里，对最高级别的重症监护病床的需求将大幅增加。我们调查结果还表明，在大量回复的病房中，非重症监护专科医生主导着护理决策。除非进行重大投资，否则需要大幅提高效率才能在未来维持这些服务的可及性。
