Critical care research in Canada is conducted primarily in “academic” hospitals, usually located in large urban centres. “Academic” centres only account for approximately 35% of all hospital beds across Canada. As a result, studies only enrol a minority of patients in Canada, thereby limiting the rate of recruitment and representativeness, threatening the generalizability of the findings to the broader Canadian context. Engaging Canada’s community intensive care units (ICUs) in research has many potential benefits including the improvement of recruitment rate, result generalizability, patient care, clinical outcome and staff satisfaction.
In 2016, the ICU at Niagara Health (NH), a community hospital, embarked on the creation the Niagara Health ICU Research Program, to provide NH patients an opportunity to participate in multicentre clinical trials and observational studies. In 5 years, the Niagara Health ICU Research Program has enrolled more than 1,500 patients in over 15 research studies, providing many patients in the local region access to novel and potentially effective therapies.
Notably, during the COVID-19 pandemic, the Niagara Health ICU Research Program expanded its scope of practice and rapidly activated many COVID-19 clinical trials and observational studies to test therapeutics and gather clinical information on the novel disease. One of the clinical trials contributed to a change in practice and supported a high-impact research publication “Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial” in the Journal of American Medical Association.