Soltani S Abolfazi, Ingolfsson Armann, Zygun David A, Stelfox Henry T, Hartling Lisa, Featherstone Robin, Opgenorth Dawn, Bagshaw Sean M
Alberta School of Business, University of Alberta, Edmonton, Canada.
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.
Syst Rev. 2015 Nov 12;4:158. doi: 10.1186/s13643-015-0145-9.
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.
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).
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.
PROSPERO, CRD42015017931.
重症监护服务的供需匹配是向急需患者有效提供高级生命支持的基础。这种供需关系的不匹配会导致“重症监护病房（ICU）容量紧张”，即ICU为所有危重症患者或可能成为危重症患者提供及时、高质量重症监护支持的能力随时间变化而受到干扰。ICU容量紧张会导致护理质量欠佳，并可能直接增加不良事件、过早出院、计划外再入院和可避免死亡的风险。ICU容量的持续紧张会导致卫生资源利用效率低下，并可能对患者、其家属和一线医护人员的满意度产生负面影响。目前尚不清楚如何最佳地量化ICU因容量紧张而经历的瞬时和长期“压力”。
我们将进行一项系统综述，以识别、评估和评价ICU容量紧张的质量和性能指标，以及它们与以患者为中心、ICU层面和卫生系统层面的相关结局之间的关联。将检索电子数据库（即MEDLINE、EMBASE、CINAHL、Cochrane系统评价数据库、Cochrane对照试验中心注册库、科学引文索引和医疗保健研究与质量机构（AHRQ）-国家质量指标数据库（NQMC）），以查找关于ICU容量紧张指标的原始研究。还将检索选定的灰色文献来源。检索主题将集中在重症监护、质量、运营管理和容量方面。分析将主要采用叙述性方式。将使用美国国家质量测量和报告系统战略框架委员会提出的标准（即重要性、科学可接受性、可用性、可行性）对每个识别出的指标进行定义、特征描述和评估。
我们的系统综述将全面识别、定义和评估ICU容量紧张的质量和性能指标。这是理解容量紧张对重症监护质量和性能的影响，并制定旨在提高效率、避免浪费和更好地预测即将出现的容量短缺的创新干预措施的必要步骤。
PROSPERO，CRD42015017931。
