Grant: Planning and Dissemination Grant - Institute Community Support

Critical care is essential to the Canadian healthcare system but it is very resource intensive. Its enormous human and financial cost underscores the pressing need for high quality evidence on effectiveness, an important aspect of quality care encompassing efficacy and cost. In Canada, up to 25 percent of all hospital deaths occur in critical units. Even if one survives, there is sustained physical, cognitive and emotional disability among survivors. Families and care givers also experience significant psychological trauma during protracted recovery periods. The spectrum of patients requiring critical care services is extremely wide and ranges from those with life threatening complications of medical illnesses to those precipitated by elective surgical interventions, trauma, cancer, neurological diseases and psychiatric illnesses. Critical care consumes extraordinary health care resources. In Canada, ICU costs are estimated to account for 16 percent of hospital charges; in 2004 this was 6 billion of the 39 billion dollars spent on hospital services. A broad and rigorous Quality of Care research agenda and evaluation is imperative to reduce morbidity, to increase survival and to improve the quality of life of patients and families while keeping in view sustainability. Canada's Critical Care community must develop a comprehensive quality of care agenda to achieve transformative changes. Care of the critically ill is complex, multidisciplinary and expensive. Albeit errors are not more frequent in the critical care setting, their consequences are more often dramatic owing to the extreme vulnerability of the patients. Currently, efforts to develop and implement quality indicators for critical care are not coordinated on a national level. We propose to establish a rigorous approach to setting national goals with long term achievable targets for improvements and benchmarks of meaningful measures to assist in monitoring our progress.