{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:00:44Z","timestamp":1790427644908,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Intensive care units (ICUs) represent among the most resource\u2010intensive environments in modern healthcare, generating significant operational, financial, and environmental pressures. Despite growing policy interest \u2014 including guidance from the European Society of Intensive Care Medicine (ESICM) and the Soci\u00e9t\u00e9 Fran\u00e7aise d'Anesth\u00e9sie et de R\u00e9animation (SFAR) \u2014 the integration of operational efficiency and environmental sustainability within ICU practice remains poorly understood at the level of frontline professionals. Qualitative evidence exploring how ICU staff and managers perceive and navigate these dual pressures is particularly limited in the German healthcare context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A qualitative\u2010dominant mixed\u2010methods study was conducted in a 520\u2010bed acute care hospital in North Rhine\u2010Westphalia, Germany. Seventeen semi\u2010structured interviews were conducted with purposively sampled ICU professionals, including physicians, nursing leadership, respiratory therapists, administrative staff, bed management specialists, and IT managers. Interviews lasted 35\u201350\u2009min (mean 41\u2009min) and were audio\u2010recorded and transcribed verbatim. Data were analysed using the six\u2010phase thematic analysis framework of Braun and Clarke. Secondary operational data \u2014 including 2025 ICU bed occupancy reports from the hospital's Medical Controlling department, staffing documentation, and hospital sustainability reports \u2014 were used for contextual triangulation. No patient\u2010level clinical data were accessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six major themes influencing ICU operational efficiency and sustainability were identified: (1) workforce shortages and staffing pressures; (2) patient flow and bed management constraints; (3) administrative workload and bureaucratic complexity; (4) technological infrastructure and resource management; (5) economic pressures and financial governance; and (6) sustainability awareness and environmental challenges. ICU bed occupancy, as reported in the hospital's 2025 Medical Controlling data, consistently exceeded 85%, confirming capacity pressures described by participants. Sustainability was broadly acknowledged as a relevant concern but perceived as secondary to immediate clinical priorities. Two preliminary conceptual frameworks (Figures S1 and S2)\u00a0\u2014 an ICU Operational Efficiency Model and a Sustainability Integration Model \u2014 were developed from the findings and require further external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides qualitative evidence that operational efficiency and environmental sustainability are perceived as interconnected but competing priorities by ICU professionals in a German communal hospital. Key barriers include staffing constraints, administrative burden, and limited institutional sustainability infrastructure. The two conceptual models should be regarded as preliminary frameworks derived from a single\u2010site study rather than validated practical tools. Future research should examine their external applicability and longitudinal impact through multi\u2010site evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70627","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:06:11Z","timestamp":1790337971000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Operational Efficiency and Environmental Sustainability in Critical Care: A Qualitative Study of Healthcare Professional Perspectives"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4166-5349","authenticated-orcid":false,"given":"Mohamed Achref","family":"Boubaker","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine Krankenhaus Bethanien Moers Moers North Rhine\u2010Westphalia Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2007.09.002"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157014"},{"key":"e_1_2_14_4_1","volume-title":"Grunddaten der Krankenh\u00e4user [Basic Data of Hospitals]","year":"2023"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.521"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62631-8"},{"key":"e_1_2_14_7_1","volume-title":"NHS Staff Management and Health Service Quality: Results From The NHS Staff Survey and Related Data","author":"West M.","year":"2011"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1355819614534836"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07256-9"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2025.101609"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011024"},{"issue":"3","key":"e_1_2_14_12_1","first-page":"365","article-title":"Environment and Health: 8. 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