Journal of Qualitative Research in Health Sciences

Authors

1 Assistant professor, Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Anesthesia and Critical Care Department, Chairman of Iranian Critical Care Society, Mehrad Hospital, Tehran, Iran.

3 Professor, School of Public Health, Department of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 MA Student of Healthcare Management, Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Access to intensive care unit (ICU) beds varies in different countries. Due to the population growth, aging, and longer survival of chronic patients, demand for these beds is increasing all over the world. The present study was performed to assess the management status of ICU beds in selected teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences.
Method: This qualitative study was conducted using conventional content analysis method in 2016. In this study, 25 participants were selected by purposive sampling and with maximum variation, and were interviewed by semi-structured interviews with open-ended questions. The interviews were performed in the participants' workplace and lasted between 30 and 60 min. Data were analyzed using conventional content analysis approach.
Results: After data analysis, 4 main themes including human capacities related to bed management, the relevant organizational and managerial requirements, ICU prioritized patients' admission and discharge manner, and strategies for promotion and improvement of ICU bed management status and 12 subthemes related to the management status of ICU beds were extracted.
Conclusion: According to the results, in our country, bed management in the intensive care units faces many challenges, especially in the areas related to human capacities, ICU admission and discharge prioritization method, and ICUs' monitoring and control, which need to be paid more attention. These challenges can be addressed through training more ICU specialists, observing international admission and discharge criteria, and using appropriate monitoring and control systems.

Keywords

  1. Valentin A, Ferdinande P, ESICM Working Group on Quality Improvement. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med 2011; 37(10): 1575-87. [DOI:10.1007/s00134-011-2300-7] [PMID]
  2. Braungardt T, Fought SG. Leading change during an inpatient critical care unit expansion. J Nurs Adm 2008; 38(11): 461-7. [DOI:10.1097/01.NNA.0000339476.73090.33] [PMID]
  3. Graves N, Halton K, Lairson D. Economics and preventing hospital-acquired infection: Broadening the perspective. Infect Control Hosp Epidemiol 2007; 28(2): 178-84. [DOI:10.1086/510787] [PMID]
  4. Thornicroft G, Tansella M. Balancing community-basedand hospital-based mental health care. World Psychiatry 2002; 1(2): 84-90.
  5. Mooney G, Houston S. An alternative approach to resource allocation. Applied Health Economics and Health Policy 2004; 3(1): 29-33. [DOI:10.2165/00148365-200403010-00006] [PMID]
  6. Bakker J, Damen J, van Zanten AR, Hubben JH, Protocollencommissie Nederlandse Vereiniging voor Intensive Care. Admission and discharge criteria for intensive care departments. Ned Tijdschr Geneeskd 2003; 147(3): 110-5. [In Dutch].
  7. Robert R, Coudroy R, Ragot S, Lesieur O, Runge I, Souday V, et al. Influence of ICU-bed availability on ICU admission decisions. Ann Intensive Care 2015; 5(1): 55. [DOI:10.1186/s13613-015-0099-z] [PMID]
  8. Mahory A, Heshmati F. Norozinia Sh. Solaimani M. Role of resident anesthesia specialists in decreasing mortality rate in ICU. Iran Society of Anesthesiology & Care J 2003;41(23): 17-22. [In Persian].
  9. Tofighi S, Meskarpour Amiri M, Ameriuon A, Naseri H. Equity in distribution of intensive care beds in Iran with Gini coefficient and Lorenz curve approach. Yafteh 2011; 12(2): 75-83. [In Persian].
  10. Rafiei M, Ayatollahi SM, Behboodian J. Bed occupancy rate modeling in Shiraz hospitals. The Journal of Qazvin University of Medical Sciences 2008; 12(2): 56-62. [In Persian].
  11. Litvak N, van Rijsbergen M, Boucherie RJ, van Houdenhoven M. Managing the overflow of intensive care patients. European Journal of Operational Research 2008; 185(3): 998-1010. [DOI:10.1016/j.ejor.2006.08.021]
  12. Nicholls AG, Young FR. Innovative hospital bed management using spatial technology. Spatial Science Queensland 2007; 2: 26-30.
  13. Proudlove N, Gordon K, Boaden R. Can good bed management solve the overcrowding in accident and emergency departments? Emerg Med J 2003; 20(2): 149-55. [DOI:10.1136/emj.20.2.149] [PMID]
  14. National Audit Office. Inpatient Admissions and Bed management in NHS acute hospitals. [cited 2017 Aug 14] Available from: https://www.nao.org.uk/report/inpatient-admissions-and-bed-management-in-nhs-acute-hospitals/.
  15. Frankel LR, Hsu BS, Yeh TS, Simone S, Agus MS, Arca MJ, et al. Criteria for critical care infants and children: PICU admission, discharge, and triage practice statement and levels of care guidance. Pediatr Crit Care Med 2019; 20(9): 847-87. [DOI:10.1097/PCC.0000000000001963] [PMID]
  16. Polit DF, Beck CT. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
  17. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62(1): 107-15. [DOI:10.1111/j.1365-2648.2007.04569.x] [PMID]
  18. Grove SK, Burns N, Gray J. The Practice of Nursing Research. 7th ed. US: Elsevier; 2012.
  19. Tavkoli MR, Karimi S, Javadi M, Jabari AR. The Survey weaknesses performance-based scheme (new guidelines fee for service design) in selected teaching hospitals of Isfahan 2014, a qualitative study. Journal of Healthcare Management 2016; 6(4):81-9. [In Persian].
  20. Polit DF, Beck CT. Nursing Research: Principles and Methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
  21. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004; 24(2): 105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
  22. Flick U. An Introduction to Qualitative Research. 6th ed. US: SAGE; 2014.
  23. Proudlove N, Boaden R, Jorgensen J. Developing bed managers: The why and the how. J Nurs Manag 2007; 15(1): 34-42. [DOI:10.1111/j.1365-2934.2006.00632.x] [PMID]
  24. Yavari M, Ardehali H, Moeini M. Evaluation of intensive care unit in terms of standards of care in selected hospitals in Tehran. Journal of Medical Council of Iran. 2015; 33(2): 131-7. [In Persian].
  25. Faculty of Intensive Care Medicine, Intensive Care Society. Core Standards for Intensive Care Units. [cited 2018 Oct 9] Available from: https://www.ficm.ac.uk/sites/default/files/Core%20Standards%20for%20ICUs%20Ed.1%20(2013).pdf.
  26. Beacon Hospital. Job Description. [cited 2018 Sep 18]. Available from: http://www2.beaconhospital.ie/inet/JobD/ADON%202014.pdf.
  27. Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med 2016; 44(8): 1553-602. [DOI:10.1097/CCM.0000000000001856] [PMID]
  28. Nasiripour AA, Ali Muhammad Zadeh K, Khosrow Abadi Q. Line waiting to receive ICU services in hospitals affiliated to Shahid Beheshti University of Medical Sciences and the factors affecting it. Journal of Healthcare Management 2009; 1(1): 1-10. [In Persian].
  29. Mirzanejad M. Survey the indications of admitting patients in internal ICU and the rate of mortality in Emam Khomeini hospital [dissertation]. Ardabil: Ardabil University of Medical Sciences; 2013.
  30. Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, et al. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Crit Care Med 2003; 31(11): 2677-83. [DOI:10.1097/01.CCM.0000094227.89800.93] [PMID]
  31. Reader TW, Flin R, Mearns K, Cuthbertson BH. Developing a team performance framework for the intensive care unit. Crit Care Med 2009; 37(5): 1787-93. [DOI:10.1097/CCM.0b013e31819f0451] [PMID]
  32. Khorami Markani A, Saheli S, Sakhaei S, Khalkhali HR. Assessment the effect of family centered care educational program on home care knowledge among care givers of patients with chronic renal failure under hemodialysis. Journal of Urmia Nursing and Midwifery Faculty 2015; 13(5): 386-94. [In Persian].
  33. Cress CJ. Handbook of Geriatric Care Management. 3rd ed. USA: Jones & Bartlett Publishers; 2011.