Intensive care in critical access hospitals

Area of Science:

• Healthcare Management
• Rural Health Services
• Critical Care Medicine

Background:

• Critical Access Hospitals (CAHs) face limitations in bed capacity and length of stay.
• Despite constraints, some CAHs provide essential Intensive Care Unit (ICU) services.

Purpose of the Study:

• To detail the resources, patient types, and perceived impacts of ICU services in CAHs.
• To understand the role of CAH ICUs in rural healthcare delivery.

Main Methods:

• Conducted semistructured interviews with Directors of Nursing at CAHs offering ICU care.
• Focused on gathering data on facilities, equipment, staffing, patient demographics, and perceived consequences of service cessation.

Main Results:

• Two-thirds of CAHs have dedicated ICU units, commonly equipped with electrocardiography and ventilators.
• Nurse-to-patient ratios (1:1 to 1:3) and staff certifications are key ICU characteristics.
• CAHs primarily treat cardiac, respiratory, and postsurgical patients, with closures seen as detrimental to patients, staff, and community perception.

Conclusions:

• CAH intensive care exists on a spectrum, from scaled-down ICUs to monitored medical-surgical beds.
• Nurse-to-patient ratio is a defining feature of CAH intensive care, more so than technology.
• CAH ICU services are perceived as crucial for hospital viability and community well-being.