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Original ResearchCRITICAL CARE MEDICINEIntensive Care Services in the Veterans Health Administration
Section snippets
Survey Administration and Content
The 2004 ICU survey was conducted under the auspices of the VHA National Program Office for Pulmonary and Critical Care. It was distributed via electronic mail through regional offices to each of 126 Veterans Affairs (VA) medical centers providing acute inpatient care. Regional divisions of VHA are called Veterans Integrated Service Networks (VISNs). There are 21 VISNs within the VHA, responsible for budgeting and developing clinical policy and decision making, such as referral patterns. We
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
Discussion
This study updates information from the 1990 survey of VHA ICUs2 and provides the first assessment of regional variation in levels of ICU care in the largest integrated health-care system in the United States. In the two articles34 reporting on ICU organization in the United States from the early 1990s, results were aggregated to the entire United States. The 1991 survey reported in these studies preceded development of ICU levels,17 so results were not presented by level of care. Subsequent
Conclusions
This study was unique in describing intensive care services by ICU level and by region. We describe variation across the VHA in key aspects, including availability of the highest ICU level, and in key factors described in the literature as associated with outcomes. Overall, the picture of the VHA system shows a fair amount of regional variation, but level 1 ICUs are available in all geographic regions, and there are regional clusters of all levels. This suggests that while the VHA should
ACKNOWLEDGMENT
Special thanks is given to the 2004 Survey of Intensive Care Units in VHA Technical Advisory Group for their guidance and support of this project: Peter Almenoff, MD, FCCP, National Program Director Pulmonary and Critical Care Medicine, Network Director VISN 15, Kansas City, MO; Thomas Craig, MD, Medical Services Officer, VAHQ, Washington, DC; Ralph G. Depalma, MD, National Director of Surgery, VAHQ, Washington, DC; Rhonda Eisenzimmer, RN, MSN Clinical Manager, VAMC, Fresno, CA; Robert Jesse,
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2019, Journal of Pain and Symptom ManagementCitation Excerpt :These facilities were grouped together as the intervention arm. We matched control facilities to intervention facilities 3:1 based on the following characteristics listed in order of matching priority: 1) ICU characteristics (separate medical/cardiac ICU and surgical ICU vs. mixed medical-surgical ICU); 2) VA-designated ratings of facility complexity based on patient population, complexity of clinical services, trainee, and research involvement; 3) same geographic region or as close geographically as possible; and 4) comparable annual number of ICU admissions (within 50% of the case facility if possible).9 All facilities included in this study in either the control or intervention arm were rated 1a-1c, where 1a is most complex.
Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration
2019, Journal of Critical CareCitation Excerpt :These 30 categories were condensed to urban and large rural (subsequently referred to as rural) based on a commonly used algorithm [31]. Additionally VA uses a 4 tier classification of ICUs to account for the broad range of critical care services offered across its health care system – from highly complex (Level 1) to basic (Level 4) – adapted from a 3 tier system in the private sector [32,33]. Because rural VA ICUs have been exclusively categorized as Levels 3 and 4, we only included urban ICUs that were similarly classified.
Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits
2017, Intensive and Critical Care NursingStaff acceptance of a telemedicine intensive care unit program: A qualitative study
2013, Journal of Critical CareCitation Excerpt :The first advanced Tele-ICU was implemented in the VA Midwest Health Care Network (VISN 23), which serves more than 400 000 geographically dispersed veterans from ten highly rural Midwestern states [21]. VISN 23 includes 8 ICUs at 7 facilities that vary substantially in their structural and organizational characteristics (Table 1) [22]. Intensive care units are located within 3 tertiary care medical centers (Iowa City, Iowa; Minneapolis, Minn; and Omaha, Neb), a small urban hospital (Des Moines, Iowa), and 3 rural hospitals (Fargo, ND, Ft Meade, SD, and Sioux Falls, SD).
Critical care nurse burnout in veterans health administration: Relation to clinician and patient outcomes
2021, American Journal of Critical CareCitation Excerpt :We used the VA system approach for classifying ICUs as basic, moderate, or complex. The site-level classification system is adapted from the private sector and takes into account the availability of subspecialists, pharmacy, diagnostic and therapeutic radiologic procedures, and laboratory services.32 We included academic teaching affiliation and US census region.
Impact of workplace climate on burnout among critical care nurses in the veterans health administration
2020, American Journal of Critical CareCitation Excerpt :Nursing-specific response rates were 52.6% (36 112 of 68 654) in 2016 and 53.7% (37 526 of 69 864) in 2017. The VA employs approximately 5000 nurses in the ICU setting, who work in more than 200 ICUs with nearly 2000 beds. 23 We filtered AES responses to include only registered nurses who self-reported their primary service area as “intensive care unit– critical care.”
The views expressed in this article are those of the authors and do not reflect the views of the Department of Veterans Affairs.
The authors have no conflicts of interest to disclose.
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Members of the 2004 Survey of Intensive Care Units in VHA Technical Advisory Group are listed in the Appendix