Outcomes from smaller intensive care units across the State are just as good as those achieved by larger ICUs, according to a new report. Mortality rates for all 26 ICUs were within acceptable ranges, whether or not patients were treated in larger units seeing over 200 patients a year, an audit found.
The finding, which will come as a booster to health campaigners outside the main urban centres, differs from international experience, where outcomes in larger units were generally found to be better.
The finding reflects well on the consistent quality of care provided in Irish hospitals, and may be attributable to a high number of transfers between hospitals, according to the Irish National ICU Audit annual report for 2021. Transfers, mostly from smaller to larger units, accounted for 8 per cent of all ICU admissions.
“The equity in mortality outcomes between smaller and larger ICU units demonstrates the adaptability of our national network, where patients receive consistent, high-quality care regardless of the size of the unit that patients are initially admitted to,” said Prof Rory Dwyer, clinical lead of the audit.
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He said despite ICU patients being among the sickest, 74 per cent of those admitted to intensive care survived to leave hospital alive.
An average of 303 ICU or high-dependency unit beds were open each day in 2021, corresponding to six critical care beds per 100,000 people. This is less than half the OECD average of 14.1.
Average bed occupancy was 88.5 per cent, above the recommended maximum of 85 per cent, though in many larger hospitals it exceeded 90 per cent.
Covid-19 patients accounted for 29 per cent of all ICU beds occupied in 2021. Over one-third (36 per cent) of Covid-19 patients died in hospital, compared to the overall ICU mortality rate of 24 per cent.
The number of pregnant or recently pregnant women admitted to ICU increased to 196, 31 per cent higher than in 2020. This figure included nine women who had had terminations. All 73 pregnant women who were admitted to ICU due to Covid-19 in 2021 survived.
Brain death was diagnosed in 103 patients, but only 50 of these became organ donors. The biggest factor in patients not becoming an organ donor was families not agreeing to organ donation.
The proportion of all deceased patients who progressed to become organ donors has fallen since 2019 from 4.7 per cent to 3 per cent in 2021.
Prof Dwyer said high bed occupancy rates needed to be addressed, and inter-hospital transfers optimised.
