Canadian Health&Care Mall: Outcomes of Intensive Care Services in the Veterans Health Administration

VHA ICUs

Description of VHA ICUs

A total of 213 ICUs were reported at 126 separate locations (Table 3). Seventy hospitals had one ICU, with a range from one to four ICUs. The South had the largest number of ICUs (n = 90). The mix of ICU types varies by region of the country, with single-specialty ICUs dominating in the South, and mixed ICUs dominating in the other three regions. Half the ICUs were single specialty, mostly surgical.

There was regional variation in the number of beds in each region (Fig 1, Table 3), and in the proportion of beds in each ICU level. The Northeast had the lowest proportion of level 1 beds, followed by the Midwest, the West, and the South. Standardized by the number of patient discharges in a year, the Midwest had the lowest number of total beds per 1,000 patient discharges, followed by the Northeast, the West, and the South. It is notable that all four regions were similar in the proportion of total ICU beds per 1,000 patient discharges. There was variation in the proportion of ICU to total beds by level across regions, as well as differences in pattern. Use the Canadian Health&Care Mall’ https://canadianhealthncaremall.com/ remedies to treat various diseases.

There was more variation in the proportion of level 1 beds per 1,000 patient discharges (Table 3), Summing level 1 and level 2 beds, however, there was less difference between highest and lowest, with the South still leading with 3.1 beds per 1,000 patient discharges.

Organizational Factors Associated With Patient Outcomes

Of the 213 ICUs, 126 were either closed or open with mandatory consultation (Table 4). The proportion of ICUs that were closed or open with mandatory consultation varied somewhat across the system, from 41% in the West to 69% in the South. There was little regional variation in the proportion of ICUs in which the director has CCM board certification. RN staffing varied in the proportion of RN FTEEs per 1,000 patient discharges, from a high of 9.2 in the West to 8.2 in the Midwest. Overall, the number and proportion of CCRNs was low, without much variation. Unit managers were also asked to report the RN/patient ratio; on average, this was 1:2, with little variation by region or ICU level.

Fig1

Figure 1. 2004 operational (staffed) ICU beds per 100,000 unique patients.

Table 3—ICUs Within the VHA

Variables Northeast
Region
South Region Midwest Region West Region VHA
Total
VISNs included in region 1, 2, 3, 4, 5 6, 7, 8, 9, 16, 17 10, 11, 12, 15, 23 18, 19, 20, 21, 22 21
Facilities, No. 26 41 31 28 126
Facilities by ICU level, No. (% of total No. of facilities in region)
Level 1 10 (38) 19 (46) 12 (39) 11 (39) 52 (41)
Level 2 6(23) 8(20) 5(16) 4(14) 23 (18)
Level 3 5(19) 8(19) 7 (22) 6(21) 26 (21)
Level 4 5(19) 6(15) 7 (22) 7 (25) 25 (20)
ICUs, No. 37 90 45 41 213
ICU types
Medical 4 18 2 5 29
Surgical 8 25 12 8 53
Cardiac care 3 16 2 3 24
Mixed 22 26 28 24 100
Other specialty 0 5 1 1 7
Total operating ICU beds, No. 339 795 388 384 1,906
Operating ICU beds by level, No. (% of total ICU operating beds in region)
Level 1 187 (55) 577 (73) 239(62) 248 (65) 1251 (66)
Level 2 85 (25) 126 (16) 65 (17) 58 (15) 334 (17)
Level 3 45 (13) 60 (8) 46 (12) 50 (13) 201 (10)
Level 4 22 (6) 32 (4) 38 (10) 28 (7) 120 (6)
ICU beds as proportion of total facility beds by level, %
Level 1 24 21 22 20 22
Level 2 14 14 14 22 15
Level 3 22 17 19 16 18
Level 4 22 17 20 15 18
Total patient discharges in FY 2003, No. 99,011 226,816 123,141 111,210 560,178
ICU beds per 1,000 patient discharges FY 2003, No. 3.42 3.5 3.15 3.45 3.4
Level 1 ICU beds per 1,000 patient discharges in FY 2003, No. 1.89 2.64 2.05 2.39 2.33
Percentage of national average 81 113 88 103
Level 1 and 2 ICU beds per 1,000
patient discharges in FY 2003, No.
2.75 3.10 2.57 2.75 2.83

Table 4—Factors Associated With Improved Patient Outcomes

Variables Northeast Region South Region Midwest Region West Region VHA Total
VISNs included in region 1, 2, 3, 4, 5 6, 7, 8, 9, 16, 17 10, 11, 12, 15, 23 18, 19, 20, 21, 22 21
Facilities, No. 26 41 31 28 126
ICUs, No. 37 90 45 41 213
Total patient discharges in FY 2003, No. 99,011 226,816 123,141 111,210 560,178
Total closed or mandatory consult open ICUs, No. 24 62 23 17 126
Percentage of closed or mandatory consult open ICUs 65 69 51 41 59
Percentage of ICUs with CCM board-certified directors 62 63 64 58 62
RN FTEEs in ICU, No. 846 2,020 1,009 1,022 4,898
RN FTEEs per 1,000 patient discharges FY 2003, No. 8.5 8.9 8.2 9.2 8.7
RNs with CCRN certification, No. 118 240 119 149 626
Percentage of RNs with CCRN certification 13 12 11 14 13