Ominous lack of intensive care beds in the Republic

Among the recommendations of the jury at the inquest of the late Dhara Kivlehan was that a database of all available critical care beds be made known to all hospitals in the Republic. This rider to the verdict of death due to medical misadventure was made after the inquest heard that Sligo Regional Hospital had no intensive care unit (ICU) bed for Ms Kivlehan when she developed pregnancy complications while subsequently, at tertiary hospital level, neither Galway nor Dublin could provide intensive care facilities.

This is a worrying revelation that has led to calls for the Health Service Executive (HSE) to carry out an audit to ascertain if sufficient intensive care beds are available in the system. That a full audit of ICU facilities in the State was carried out exactly five years ago by Prospectus consultants with specific recommendations for improvement is hardly reassuring.

The 2009 Prospectus report identified a need to radically reconfigure existing critical care services. An audit carried out by the consultants found evidence of undercapacity by directly measuring the level of ICU admission refusals and the early discharge of critically patients at that time. Prospectus recommended an immediate 45 per cent increase in critical care capacity, with the number of ICU beds rising from 289 to 418. Furthermore it flagged a need to increase the number of beds progressively to 579 over the period from 2010 to 2020.

The experience of Ms Kivlehan some four years ago suggests the under-provision of beds continued after the report. And a management board meeting at Cork University Hospital last April noted its ICU was running at full capacity with 10 beds but with a need for 28 staffed critical care beds, pointing to a persisting problem.

That there is a clear threat to patient safety in our health system some 5 years after it was identified is unacceptable. Minister for Health Leo Varadkar must ask senior HSE management for an urgent explanation.

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