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My impression as a Canadian resident was the bar seemed a lot lower to get into the ICU in the US. Unless they needed a tube to secure an airway, pressors, or C

by _uvv0 4y ago

My impression as a Canadian resident was the bar seemed a lot lower to get into the ICU in the US. Unless they needed a tube to secure an airway, pressors, or CRRT we managed COPD with BiPAP, pretty profound hyponatremia, cirrhosis with& bleeds, DKA/HHS on the ward pretty regularly just as examples of repatriated patients I remember. I always figured it was due to an overly litigious culture and a money maker for the hospital. To be clear I didn't practice in the US.

haldujai 4y ago
It’s probably because we don’t have enough ICU (or step down beds) in Canadian hospitals than the fear of litigation in the US. Canada’s capacity is amongst the least in G20 nations. A lot of patients we manage on the ward or step downs (i.e. pressors on step down, I’m unaware of any ward that will let you run these, very few tolerate central lines) really should be in a full ICU, or at least a high level step down unit like D4ICU at KGH (rather than the hilariously awful AMA units at TOH).
- throwaway2037 4y ago
  I am going to repeat myself here. You wrote: <<Canada’s capacity is amongst the least in G20 nations.>> Not even close. Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity https://www.oecd.org/coronavirus/en/data-insights/intensive-... Canada: 12.9 / 100K population (slightly higher than OECD average) For the record, it is usually better to quote "OECD" than "G20". G20 just means total GDP is large, but GDP per capita can be very low, like India, Indonesia, and China. OECD is always (democratic and) high-income -- high GDP per capita. For example: Nederlands, Norway, and Switzerland are all OECD, but none G20. All are very high income and high human development.
  - haldujai 4y ago
    This number includes level 2/step-down ICUs inclusive of regional/community hospital. This is not the bed count of units capable of having cardiac support or prolonged ventilation. I can’t readily find the OECD figure but if you look at ventilator capable beds in Canada the number drops to ~9.7, again inclusive of community/regional hospitals mostly staffed by non-ICU trained physicians which are only equipped for short term ventilation. Which center in Canada have you trained at where there isn’t constant pressure to offload ICU patients to the ward due to a lack of beds?

by _uvv0 4y ago

haldujai 4y ago

It’s probably because we don’t have enough ICU (or step down beds) in Canadian hospitals than the fear of litigation in the US. Canada’s capacity is amongst the least in G20 nations. A lot of patients we manage on the ward or step downs (i.e. pressors on step down, I’m unaware of any ward that will let you run these, very few tolerate central lines) really should be in a full ICU, or at least a high level step down unit like D4ICU at KGH (rather than the hilariously awful AMA units at TOH).

throwaway2037 4y ago
I am going to repeat myself here. You wrote: <<Canada’s capacity is amongst the least in G20 nations.>> Not even close. Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity https://www.oecd.org/coronavirus/en/data-insights/intensive-... Canada: 12.9 / 100K population (slightly higher than OECD average) For the record, it is usually better to quote "OECD" than "G20". G20 just means total GDP is large, but GDP per capita can be very low, like India, Indonesia, and China. OECD is always (democratic and) high-income -- high GDP per capita. For example: Nederlands, Norway, and Switzerland are all OECD, but none G20. All are very high income and high human development.
- haldujai 4y ago
  This number includes level 2/step-down ICUs inclusive of regional/community hospital. This is not the bed count of units capable of having cardiac support or prolonged ventilation. I can’t readily find the OECD figure but if you look at ventilator capable beds in Canada the number drops to ~9.7, again inclusive of community/regional hospitals mostly staffed by non-ICU trained physicians which are only equipped for short term ventilation. Which center in Canada have you trained at where there isn’t constant pressure to offload ICU patients to the ward due to a lack of beds?