Objective: To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital.
Design, Setting, Subjects: This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13).
Measurements and Main Results: Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions.
Conclusions: This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.
1Division of Critical Care, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
2The Academy for Innovation in Medical Education (AIME), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
3Practice, Performance and Innovation (PPI) Unit, The Royal College of Physicians and Surgeons of Canada (RCPSC), Ottawa, ON, Canada.
4School of Nursing, The University of Ottawa, Ottawa, ON, Canada.
5University of Ottawa Skills and Simulation Centre (uOSSC), Ottawa, ON, Canada.
* See also p. 984.
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Supported, in part, by the Canadian Institutes of Health Research, the Champlain Local Health Integration Network, and The Ottawa Hospital Department of Critical Care.
Presented, in part, at The Association for Medical Education in Europe (AMEE) Annual Conference 2012 in Lyon, France; and the Academy for Innovation in Medical Education Research Day 2012 in Ottawa, Canada.
Ms. Landriault received support for travel, support for article preparation, and is employed by the Royal College of Physicians and Surgeons of Canada. Ms. Landriault’s institution received grant support from the Canadian Institutes of Health Research (CIHR) and Champlain Local Health Integration Network (LHIN). Dr. Willett is employed by the Royal College of Physicians and Surgeons of Canada and received support for article research from the CIHR. Dr. Willett’s institution received grant support from the CIHR; University of Ottawa, Division of Critical Care; and the Champlain LHIN. Dr. Cardinal is employed by the Royal College of Physicians and Surgeons of Canada. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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