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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000036
Clinical Investigations

Comprehensive Assessment of Critical Care Needs in a Community Hospital*

Sarti, Aimee J. MD1,2,3; Sutherland, Stephanie PhD2; Landriault, Angèle BScN3; Fothergill-Bourbonnais, Frances RN, PhD4; Bouali, Redouane MD1; Willett, Timothy MD, MMedEd3; Hamstra, Stanley J. PhD2,5; Cardinal, Pierre MD, MScEpi1,2,3

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Abstract

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).

Interventions:

None.

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.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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