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Canadian Critical Care Capacity · • Rob Fowler • Noel Gibney • John Granton • Rob Green...
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Canadian Critical Care Capacity Rob Fowler MDCM, MS, FRCP Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital Associate Professor, University of Toronto
Transcript of Canadian Critical Care Capacity · • Rob Fowler • Noel Gibney • John Granton • Rob Green...
Canadian Critical Care Capacity
Rob Fowler MDCM, MS, FRCP Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital Associate Professor, University of Toronto
CCCTG Critical Care Capacity Study Team
• Philip Abdelmalik • Neill Adhikari • Sean Bagshaw • Natalie Bandrauk • Deborah Cook • Peter Dodek • Denise Foster • Ryan Foster • Rob Fowler • Noel Gibney • John Granton • Rob Green • Andrea Hill
• Philippe Jouvet • Anand Kumar • François Lamontagne • Bernard Lawless • John Marshall • Claudio Martin • Louise Rose • Damon Scales • Susan Shaw • Henry Stelfox • Alexis Turgeon • Gordon Wood • Ryan Zarychanski
CCCTG Critical Care Capacity Collaborators
• Yukon : KD Braden, Nora Tremblay, Bendan Hanley, Rowena Beckett, Karin Heynen.
• Northwest Territories : Ivan Russell, Kami Kandola, Kathie Pender, Elaine Kelly.
• Nunavut : W. Alexander (Sandy) MacDonald.
• British Columbia : Tracey Miller, Lynn Tran, Lauren Tindall, Michelle Stuart, Kevin Carriere, Elizabeth Jolley, Gordon Krahn, Jim Fitzpatrick, Lynn Smiley, Coleen Hay,Ophelia Spencer, Darla Roberts, Christina Gordon, Barb Caldwell, Jo-Annne Rondeau, Karen L Watson, Morag Mochan, Joanne Cozac, Cheryl Scovill, Kathey Yeulet; Suzanne Johnston, Ray Taylor, Pat Tresierra, Rob Fingland, Christopher Gagnon, Monique Roy-Michaeli, Grzegorz Martinka, David Wensley, Peter Skippen, Sneeta Takhar, Don Griesdale.
• Alberta : Monique Roy-Michaeli, Ari Joffe, Elaine Gilfoyle, P Wickson, Catherine Ross, Chip Doig, Paul Boiteau, David Zygun.
• Saskatchewan : Susan Lyons, Anita Sagadahi, Laurie Albinet; Gayle Riendeau, Pam McKay, Ndrew McLetchie; Barbara Jiricka, Carol Gregoryk, Val Davies, Valerie Mann, Saqib Shahab, Patrick O’Byrne, Diane Larrivee, Sandy Bradford-Macalanda, Alice Wong.
• Manitoba : Kimberly Webster, Scott Cleghorn, Gregg Eschun, Allan Garland, Charlie Penner, Murray Kesselman, Gordon Kasian.
• Ontario : Carol Moran, Jeff Singh, Judith Van Huyse, Sonny Dhanani, Jamie Hutchison, John Muscedere, Stephen Lapinsky, Kusum Menon, Karen Choong, Tom Stewart, Margaret Herridge, Douglas Fraser, Karen Burns, Niall Ferguson.
CCCTG Critical Care Capacity Collaborators
• Quebec : Baqir Quizibash, Jean Philippe Garant, Lysanne Desaindes, Vanessa Dutil, Craig Baldry, Francois Lellouche, Pjil Roula, Ash Gursahaney, Arnold Kristoff, J-S Bilodeau, Mathieu Bernier, Jean-Luc Houde, Marisa Tucci, Marc-Andre Dugas, Dina Diana, Miriam Santschi, Denny Laporta, Dominique Piquette; Davinia Withington; Germain Poirier, Martin Legare, Jacques Lacroix, Stephane P. Ahern, Dr. François Lauzier, Tina Doyle.
• New Brunswick : Carolin Galvin, Rachel Mallais, Marchel Mallet, Kathy Kowalski, Claude Violette, Stephanie Perry, Colleen Reinsborough, John Mowat, Todd Lambert, Krista Chillington, Judy Melanson, Joanne Michaud-Young, Marc Pelletier, Krista Shillington, Jean Bustard.
• Prince Edward Island : Judy Adams, Sherry Harris, Kay Kelly.
CCCTG Critical Care Capacity Collaborators
• Nova Scotia : Anne McClair, Linda Rouleau, Dietrich Henzler, Rebecca Earle, Nadine Stevens, Maria Marshall, Jill Smith, Wendy Studley, Norah Doucet, Angela Foote, Dorothy McCaskil, Sharon McCarthy, Kim Thomas, Kate Mahon, Shauna Best, Chris Soder, Rick Hall.
• Newfoundland and Labrador : Jill Barter, Gerry McCain, Kim Aduau, Sharon Penny, Valery Clarke.
• Public Health Agency of Canada : Rachel Rodin, Corey Oliver, Ahalya Mahendra, Joy Pulickal, Marianna Ofner, Kara Hayne.
CCCTG Critical Care Capacity Collaborators
Our modern day capacity for critical care is exposed during times of increased demand
Toronto 2003 SARS Epi Curve
SARS ICU Patient Characteristics
• 196 patients with SARS admitted to hospitals during study period
• 19% patients became critically ill
• 76% required mechanical ventilation • 18.4% Healthcare Workers
SARS Impact on ICU Capacity
• Among All Toronto Study Hospitals
• 6 of 13 ICUs quarantined
• 41% of the GTA ICU beds
Canadian H1N1 Epidemiologic Curve
The association of spending, ICU beds and health outcomes
Adapted from OECD: Health Data 2007 http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
Life Expectancy and per capita Health Spending
ICU beds per 100,000 Population
Health Care Spending and ICU beds per 100,000 Population
Number of ICU Beds by Country
Adhikari N, et al. Lancet 2010
“Local” Capacity Examples
ICU Occupancy in Ontario Teaching Hospitals
ICU Occupancy in Ontario Teaching Hospitals
Ontario Teaching Hospitals Night Time ICU Discharge Rate
Ontario Teaching Hospitals Night Time ICU Discharge Rate
Ontario Teaching Hospitals 48 hour Readmission Rates
Ontario Teaching Hospitals 48 hour Readmission Rates
Capacity for Care in Canada
• Fall 2009 – November 2010
• Communicated with all provincial Ministries of Health, Provincial Critical Care Societies
• Identified all hospitals in Canada
• Email and telephone based survey of critical care capacity
• Geo-coding of all hospital locations
Canadian Critical Care Capacity
• Hospital Name, Location • Presence of an ICU • Total Number of ICUs • Total Number of ICU beds: Adult, Pediatric, Mixed • Number ICU beds capable of invasive ventilation • Number of Ventilators capable invasive ventilation • Number of Non-invasive ventilators • Number of portable/transportation ventilators • Ability to provide markers of extraordinary
oxygenation support: HFO, iNO, ECMO
Canadian Critical Care Capacity Study
Canadian Critical Care Capacity
Region
# Hospitals with ICUs with
Ventilation Capacity*
ICU Beds Capable of
Invasive Ventilation
Ventilators Capable of
Invasive Ventilation
Number HFOs in
ICUs
ICUs with iNO
ICUs with ECMO
Canada 286 3170 4982 178 79 39
Canadian Critical Care Capacity
Region
Hospitals with ICUs per 100,000
Population
ICU Beds with Ventilation Capacity
per 100,000 Population
Invasive Ventilators per 100,000 Population
Newfoundland 2.8 19.3 24.4
Nova Scotia 1.5 15.0 20.3 Prince Edward Island 1.4 12.8 15.6
New Brunswick 1.2 13.8 15.1
Quebec 1.1 11.3 15.3
Ontario 0.6 8.6 16.1
Saskatchewan 1.3 10.5 22.8
Manitoba 1.0 9.0 14.7
Alberta 0.4 7.9 10.1
British Columbia 0.8 6.8 10.3
Territories 2.7 5.5 13.7
Canada 0.9 9.5 14.9
Canadian Critical Care Capacity
Region
Hospitals with ICUs per 100,000
Population
ICU Beds with Ventilation Capacity
per 100,000 Population
Invasive Ventilators per 100,000 Population
Newfoundland 2.8 19.3 24.4
Nova Scotia 1.5 15.0 20.3 Prince Edward Island 1.4 12.8 15.6
New Brunswick 1.2 13.8 15.1
Quebec 1.1 11.3 15.3
Ontario 0.6 8.6 16.1
Saskatchewan 1.3 10.5 22.8
Manitoba 1.0 9.0 14.7
Alberta 0.4 7.9 10.1
British Columbia 0.8 6.8 10.3
Territories 2.7 5.5 13.7
Canada 0.9 9.5 14.9
R² = 0.8091
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Census Division Population (2011)
Number of ICU Beds with Ventilation By Population (Census Divisions)
R² = 0.7712
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Main Messages • Canadian critical care capacity is similar to many developed
nations
• Our capacity likely operates within a very small buffer of beds in relation to demand
• There appears to be variability in capacity, within our provincially funded systems
• Recent changes in bed numbers, addition of ECMO, etc. are not reflected in this data
• We should collectively consider whether benchmarks and standards for capacity represent a quality of care target
Partners and Sponsors
Thank YOU!
Canadian Critical Care Capacity
Region
Hospitals with ICUs
with Ventilation Capacity
(N)
ICU Beds Capable of
Invasive Ventilation
(N)
Ventilators Capable of
Invasive Ventilation
(N)
High-frequency Oscillatory Ventilators
(N)
Hospitals with ICUs with iNO
(N)
Hospitals with ICUs
with ECMO (N)
Newfoundland 14 98 124 7 3 2
Nova Scotia 14 141 191 6 7 2 Prince Edward Island 2 18 22 0 0 0
New Brunswick 9 103 113 1 3 0
Quebec 87 885 1197 40 25 12
Ontario 84 1122 2101 65 19 11
Saskatchewan 13 108 235 10 3 3
Manitoba 10 93 151 10 3 2
Alberta 16 292 373 18 8 3 British Columbia 34 304 460 21 7 4
Territories 3 6 15 0 1 0
Canada 286 3170 4982 178 79 39
Number of ICU Beds per Population and ICU Mortality
