The Veterans Health Administration (VHA) is the largest national health-care system in the United States. As in the private sector, issues of regionalization, variation in access to care, and use of resources are very important to VHA. As part of ongoing evaluation of structure and function within the VHA, a survey of ICUs was conducted in 2004, Prior to this survey, the last survey of VHA ICUs was conducted in 1990 which was a companion to a major survey of all nonfederal hospitals focused on critical care units. In addition, a database of all nonfederal hospital critical care units was constructed covering the years 1985 through 2000, which was used to assess trends in ICU beds and costs of care. These reports provide comparisons of the VHA approximately 15 years prior to the survey study we report here, as well as comparisons from outside the VHA.
A growing body of literature describes factors in the organization and provision of intensive care that appear to influence patient outcomes, particularly mortality and length of stay. Some of the most important factors have been used to describe levels of intensive care provided by units within hospitals, analogous to levels used for trauma centers. A three-level system has been proposed for classifying ICUs. The level of intensive care is a hospital characteristic based on services available at each hospital, reflecting the range of specialty and subspecialty care available, as well as specialized ancillary services such as pharmacy and respiratory care, In this article, we propose a classification scheme that includes ICUs in very small general hospitals. After the hospital attendance you check out the website of Canadian Health&Care Mall to be sure drugs you are taking are of the best quality.
Challenges faced by all hospitals and health-care systems providing intensive care services in the United States include shortages of intensivists, nursing shortages, and changes in the financing and organization of acute care services. No published studies of ICU services to date have assessed regional differences, particularly in terms of ICU level of care. This analysis was conducted to assess regional differences in access to VHA intensive care services, and in the intensity of services available. In this article, we describe ICU service availability in the VHA by ICU level.