The Irish National ICU Audit annual report for 2022, set to be released on Wednesday by the National Office of Clinical Audit, indicates that there needs to be an increase in the availability of intensive-care beds and more timely discharges. This comes after a clear over-occupancy at critical care facilities. The report states that 6% of these were occupied by patients cleared for discharge.
Data in the report indicates there were 11,008 patients admitted to 26 units across 22 hospitals last year. On average, there were 289 ICU or high-dependency unit beds available daily in 2022 among publicly funded hospitals. This equates to only 5.6 critical-care beds per each 100,000 residents, a figure well below international standards. In 2022, for instance, the UK boasted 7.3 beds while the average across the Organisation for Economic Co-operation and Development (OECD) countries stood at 12.
More worrying still, critical-care units have seen a surge in bed occupancy rates over the past few years. The rate in 2022 was 92%, a jump from 88.5% the previous year, exceeding the benchmark rate of 85%. Larger units, such as Dublin’s Beaumont Hospital’s neurosurgical ICU, often recorded rates above 95%, with some hitting 100%. The implications are worrisome, as these heightened rates often mean that ICUs have no empty beds left for urgent admissions.
Moreover, patients face growing delays regarding discharges to the ward, with 27% having to wait over one day for a ward bed, up 7% from 2021. Also, patients ready to be discharged accounted for 6% or over 5,000 ICU bed days. Additionally, the audit found that in Ireland, 9% of patients initially admitted from a ward concluded with multi-organ failure within a day upon ICU admission. Furthermore, excessive delays to admit patients to the ICU were observed in five hospitals, which the report suggests, could be due to the scarcity of critical-care beds.
The re-admission rate to ICU within 48 hours of release was at 1%. Nevertheless, a couple of hospitals exceeded this range, with the author attributing this variance to premature patient release due to scarcity of ICU beds.
The frequent reasons for admitting to ICU included sepsis, respiratory complications, traumas, cardiac arrests and post-surgery care.
A declaration from HSE informed of the Government’s strategic long-term plan created in 2020, with the aim of enhancing overall critical-care capacity. The proposal focuses on creating more bed space and plans to expand the number of critical beds from 258 (as of March 2020) to 329 by December 2023. The plan also outlines an expansion in 2024, adding an extra 22 critical-care beds.