Critical care capacity in Canada: results of a national cross-sectional study

Abstract

IntroductionIntensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity.MethodsAfter the 2009–2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity. Using a structured survey tool administered to physicians, respiratory therapists and nurses, we determined the number of ICU beds, ventilators, and the ability to provide specialized support for respiratory failure.ResultsWe identified 286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs. Per 100,000 population, there was substantial variability in provincial capacity, with a mean of 0.9 hospitals with ICUs (provincial range 0.4-2.8), 10 ICU beds capable of providing mechanical ventilation (provincial range 6–19), and 15 invasive mechanical ventilators (provincial range 10–24). There was only moderate correlation between ventilation capacity and population size (coefficient of determination (R2) = 0.771).ConclusionICU resources vary widely across Canadian provinces, and during times of increased demand, may result in geographic differences in the ability to care for critically ill patients. These results highlight the need to evolve inter-jurisdictional resource sharing during periods of substantial increase in demand, and provide background data for the development of appropriate critical care capacity benchmarks.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0852-6) contains supplementary material, which is available to authorized users.

Time required to initiate outbreak and pandemic observational research

“…Outbreaks and pandemics are perceived to occur at increasing frequency; however, they remain unpredictable in their time and location of onset [1]. Outbreaks increase patient morbidity and mortality, and cause additional burden on health care workers, facilities, and health agencies [2][3][4]. Surveillance can identify cases at an early stage and lead to prevention of broader spread.…”

Projecting demand for critical care beds during COVID-19 outbreaks in Canada

“…A 2015 national cross-sectional study estimated a total of 3170 ICU beds capable of invasive ventilation across Canada. 12 To project the hospital and ICU bed demand at the peak of outbreaks, we calculated the number of existing ICU beds in each province and estimated the unoccupied ICU beds that could be used for treatment of COVID-19 patients, assuming a conservative occupancy rate of 80% for existing beds. 23…”

Canadian healthcare readiness for public health emergencies

“…At the resource level, an assessment of Canadian hospitals' ICU (Intensive Care Unit) capacity revealed a variety of ICU resources geographically that would lead to a difference in the ability to care for an influx of new patients. 6 When surveyed, 59% of trauma directors of Canadian trauma centres were not certain that their respective institutions had the capacity to sustain operations for at least 72 hours during a MCI. 7 That being said, Critical Care Ontario -the managing body for critical care services in Ontario who collaborate with hospital administrators, healthcare providers, and MOHLTC -has a Surge Capacity Management Plan for situations where critical care demand exceeds available resources at local hospitals.…”

“…In a study of Canadian trauma centres, more than 83% of respondents had committees for mass-casualty incidents but only half of the trauma directors sit on these committees. 6 When examined for their preparation for CBRN events, there was a widespread lack of standard assessment and readiness knowledge when helping contaminated patients. 9 Training for disaster situations at hospitals can also be improved.…”