Some 6 per cent of critical-care beds were occupied by patients who had been cleared for discharge, with occupancy at intensive care units regularly exceeding recommended levels, a new report has found.
On Wednesday, the National Office of Clinical Audit will publish the Irish National ICU Audit annual report on 2022, which highlights a need for increased intensive-care bed availability and prioritised discharges.
According to the audit, there were 11,008 admissions to 26 units across 22 hospitals in 2022.
It found that an average of 289 ICU or high-dependency unit beds were open daily in publicly funded hospitals in 2022, corresponding to 5.6 critical-care beds per 100,000 population.
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The report said this is low by international standards, with the equivalent figure in the UK in 2022 being 7.3 beds, and the mean value for Organisation for Economic Co-operation and Development (OECD) countries being 12.
Bed occupancy rates in critical-care units have increased in recent years. The rate in 2022 was 92 per cent, up from the 88.5 per cent the previous year. The recommended level is 85 per cent.
The audit found that many of the larger units had rates above 95 per cent, with Dublin’s Beaumont Hospital’s neurosurgical ICU having the highest occupancy rate, at 100 per cent.
The report said: “These high occupancy levels lead to periods when ICU beds are all occupied and not available for urgent admissions”.
Delays in discharges to the ward have also increased, with 27 per cent of patients spending more than 24 hours waiting for a ward bed for discharge from ICU – compared with 20 per cent in 2021.
Six per cent of all potential ICU bed days were occupied by patients for more than eight hours by patients who had been cleared for discharge to a ward. This is equivalent to 5,163 ICU bed days occupied by patients who were ready for ward care.
Nationally, 9 per cent of patients admitted from a ward developed multi-organ failure within 24 hours of admission to ICU.
Five hospitals were outside the expected range for this quality indicator, which the report said suggests admissions to ICU were delayed, possibly because of a shortage of critical care beds
The rate of unplanned readmissions to ICU within 48 hours of discharge was 1 per cent. However, two hospitals were outside the expected range for this, with the author suggesting this was a consequence of premature discharges due to a shortage of ICU beds
Common reasons for admission to ICU were sepsis, respiratory failure, trauma, cardiac arrest and having had surgery.
In a statement, the HSE said the Government’s strategic multiyear plan for additional permanent adult critical-care capacity was developed in 2020 to support the long-term strategic goal of increasing overall critical-care capacity.
The plan includes targets to deliver additional beds, with the number of critical-care beds increasing from 258 in March 2020 to 329 at the end of December 2023. In 2024, a further 22 critical-care beds are planned, the statement added.
Dr Andrew Westbrook, an intensive care consultant at St Vincent’s hospital, said the shortage of ICU beds has a direct impact on patients, as their admittance to ICU is delayed.
“It means that they get sicker on the ward. The longer you delay, the more likely they are to die or the sicker they are when they get into the intensive care unit. And the sicker they are when they get into the intensive care unit, the more likely they are not to survive their illness,” he told RTÉ Radio 1’s Morning Ireland.
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