Report highlights wide variations in intensive care

BMJ 1995; 310 doi: (Published 18 February 1995) Cite this as: BMJ 1995;310:420

Health authorities in Britain have been instructed to review their use of intensive care services after a government report found wide variations in both the number of intensive care beds and the type of patients admitted.

The report, based on a study conducted in May and June of 1993 by the health promotion sciences unit at the London School of Hygiene and Tropical Medicine, concluded that one in six referrals to intensive care were “inappropriate.”

The report highlights uneven distribution of intensive care units (ICUs) around the country, noting that “there is considerable clustering of ICUs in major urban areas. For instance within London's inner ring road 24 hospitals support 161 intensive care beds, in units which mostly had 5 or more staffed beds.”

This contrasts with another of the study's findings, that under half the 234 units surveyed had more than four staffed beds. Overall, the report shows an almost twofold difference in the numbers of staffed intensive care beds among different health regions.

Nearly three quarters of the intensive care units in the study were without a full time medical director. Four had no nominated consultant in charge. The study describes the level of consultant involvement as “disturbing.”

It also says: “Most worrying, however, was the finding that in 39% of responding units no consultant, of any specialty, was present at any time during the census day.”

The government's study also reported that the highest refusal rates were found in areas with the lowest supply of beds. The report adds: “Factors such as whether a hospital is a specialist referral centre and/or has other hi tec beds, reflect the nature of the hospital within which the ICU provides a service. Referrals of patients to hospitals with these facilities will necessarily increase the chances of ICU referral, and thus the possibility of refusal of admission.”

The collection of data for the study proved difficult because, says the report, “It is clear that many units do not collect data routinely, no doubt because of time constraints and lack of computer resources. This is compounded by the lack of support staff on the units: only half the ICUs had ward clerks, one quarter had secretarial staff, and only 15% had any sort of support from audit assistants.”

Junior health minister Tom Sackville said: “There is a difficult balance to strike. It is no good hospitals establishing larger intensive care facilities to satisfy peaks of demand. Highly staffed beds then lie empty the rest of the year.” Mr Sackville said that he had asked all health authorities to review whether facilities were adequate and were being used in the most effective way.—CLAUDIA COURT, BMJ

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