‘Ongoing shortage’ of ICU beds in Ireland, intensive care audit finds

Irish patients were sicker on admission to intensive care units than their counterparts in the United Kingdom, indicating an “ongoing shortage” of ICU beds in Ireland, according to a new report.

Some 14 per cent of patients admitted to ICU died before discharge from the unit in 2020, the report from the National Office of Clinical Audit (NOCA), published on Wednesday, has found.

A further 7 per cent died before discharge from acute hospital, meaning 79 per cent of patients admitted to ICU survived to leave hospital.

The numbers of open ICU beds increased in 2020 in anticipation of a surge in admissions related to Covid-19.

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However, the high level of sickness among patients being admitted to ICU, among other metrics in the report, suggested an “ongoing shortage” of ICU beds, it said.

The number of patients who developed organ failure in four or more organ systems within 24 hours of admission to ICU was outside the expected range in St Vincent’s University Hospital ICU.

“The hospital indicated that a shortage of ICU beds was a factor in delaying admission to ICU that contributed to this finding,” the report added.

Delayed discharges from ICU were also common across most units, according to NOCA.

Nationally, 3.6 per cent of all potential ICU bed days were occupied by patients who had been cleared for discharge to a ward for more than 8 hours.

“This led to ICU beds being occupied by patients who could have been cared for in a ward while the admission of critically ill patients to ICU was delayed,” the report added.

During 2020, the Irish National Intensive Care Unit Audit documented the care of 11,177 critically ill patients who had 11,793 admissions to ICU.

The average length of stay for each ICU admission was 5.8 days and total bed days occupied were 68,400. There were 700 admissions of patients with Covid-19 which accounted for 5.9 per cent of all ICU admissions in 2020.

A total of 703 critically ill patients were transferred from one hospital to ICU in another hospital in 2020.

“This was an essential component in maintaining the quality of care provided to all critically ill patients,” NOCA said.

The audit said bed occupancy rates were “difficult to calculate” because of the variability in numbers of beds that were opened for Covid patients.

Pre-Covid, 88 per cent occupancy was the baseline figure, with available data between March 26th and December 31th, 2020, showing 79 per cent occupancy, though the two figures are calculated through different methods.

“Thus, the available data suggest that bed occupancy was lower in 2020 than in 2019 because additional “surge” beds were open, and because the number of non-Covid-19 patients admitted to ICU decreased,” it added.