Ireland's ICU facilities can deal with just 411 patients, warn critical care specialists

Ireland’s hospital system can deal safely with just 411 patients requiring intensive care facilities, critical care specialists have maintained.

In a letter to Taoiseach Leo Varadkar and other politicians, they have argued that efforts must be made to identify how and where capacity can be quickly increased as the lives of critically -ill patients will depend on it.

The representatives of various organisations in the critical care community in Ireland warned that recent surge capacity, which has been developed in the face of the Covid-19 pandemic, represented "a short-term solution" and was "not sustainable".

It said the surge capacity was “ provided by staff who are redeployed working with the support of intensive care unit staff”.

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“They will ultimately have to return to their usual posts to provide services to our non-Covid population who will require definitive care in the next few weeks to months as we move through this pandemic. As the curve is controlled in due course, those patients requiring complex surgery for cancer, heart disease, transplant and other surgeries will need access to care and have the same right of access to critical care as patients suffering from Covid-19.”

“Ethically and morally this country must insist that the required expansion in intensive care unit capacity is funded, so we can offer appropriate care to all our critically ill patients and cope with the difficult months ahead. Our pre-pandemic intensive care unit occupancy of 88 per cent nationally and over 96 per cent in major units is well above the international recommended rate of 75 per cent.”

“For too long the request of the critical care community for appropriate capacity has been deferred. serial reports over the past 15 years have consistently documented the inadequacy of critical care capacity in Ireland.”

“It is now time to identify how and where we can expand capacity in the short term. We must assist hospitals to quickly build appropriate isolation facilities which are urgently required. We have to recruit and retain the additional staff required. This will be a challenge, but we have no time to prevaricate. The lives of patients who will require timely access to critical care will depend on it.”

The letter to the Taoiseach and opposition parties was drawn up by organisations including the Intensive Care Society of Ireland, the Irish Association of Anaesthetists, the Joint Faculty of Intensive Care Medicine of Ireland, the College of Anaesthesiologists of Ireland and the Irish Association of Critical Care Nurses.

The letter said that the European Centre for Disease Prevention and Control (ECDC) guidance (25/3/2020) and international evidence indicated that hospitals needed critical care capacity sufficient to admit up to 15 per cent of hospitalised cases to critical care. It said the ECDC identified that Ireland “was at extremely high risk of saturation of its baseline intensive care unit capacity even at rates of hospitalised cases well below every other European country”

The letter also said the HSE had estimated as far back as 2009 that there should be 579 critical care beds by 2020 while a more recent capacity review in 2018 suggested 430 beds by 2021.

"Recent funding in March of this year from HSE/Department of Health brought our base adult critical care bed numbers from 257 adult beds (197 level 3 and 60 level 2) to 285 (239 level 3 and 46 level 2), still far short of the HSE own recommendations (by 145 beds). This is insufficient to deal with the additional high numbers of critically ill patients with Covid-19 in addition to our usual cohort of critically ill patients."

The letter said the intensive care community with the help of large numbers of staff redeployed from many other specialities had created additional capacity in a truly short time frame to cope with the expected surge in cases of Covid-19 presenting to our hospitals.

“We are enormously grateful for the cooperation of all staff who have stepped up in this unprecedented situation. Most of our elective and semi-urgent work requiring critical care has been deferred to create capacity. We are concerned for the many patients who wait anxiously with serious diagnoses for access to care and we are keen that their needs are addressed.”