Rationing intensive careBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6991.1412b (Published 27 May 1995) Cite this as: BMJ 1995;310:1412
Intensive care provision varies widely in Britain
- G B Smith,
- B L Taylor,
- P J McQuillan,
- E Nials
- Director, intensive therapy services Consultant in intensive care and anaesthesia Consultant in intensive care and anaesthesia Associate general manager, intensive therapy services Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY
EDITOR,—D W Ryan believes that high dependency units will solve some of the problem of insufficient beds in intensive care units in Britain andsuggests that some elective admissions to intensive care units could be diverted to such a unit, thereby freeing beds.1 Indeed, the fact that roughly 42% of admissions to Ryan's unit are elective surgical cases might seem to support this view. Furthermore, the small number of patients whose operations were cancelled or who had to be transferred from the unit suggests that Newcastle might be reasonably well supplied with beds in intensive care units.
Unfortunately, Ryan's figures may not be representative of other centres, particularly as the Department of Health's recent audit report highlighted a wide variation in the provision of beds in intensive care units in England.2 For instance, in 1993 the Wessex region had an average of 1.9 beds per 100000 population yet the figure for the Northern region was 2.6.2 Portsmouth Hospitals NHS Trust has only nine intensive care unit beds to serve a local population of about 550000—a ratio of 1.63—and this fails to recognise the presence of a regional renal unit.
Our data (table) show a different picture from that described by Ryan1 and others.3 The monthly occupancy in intensive care units in Portsmouth varies between 70% and 98%, 86% of admissions require treatment on the basis of Wagner et al's criteria,4 and only 17% of admissions occur after elective surgery. Less than 6.5% of bed days are accounted for by patients who are not ventilated. In the past two years operations (mainly for aortic and oesophageal surgery) were cancelled on at least 205 occasions because of the lack of an intensive care unit bed and 58 patients in the intensive care unit were transferred to other units, sometimes up to 130 km away, simply to permit a sick patient to be admitted as an emergency. An unknown number of emergency patients were also transferred direct from general wards or the accident department, simply because of a lack of intensive care unit facilities.
Clearly, the solution to the shortage of intensive care unit facilities may not be the same for all regions, trusts, or intensive care units. For some the development of a high dependency unit will ease pressure on intensive care unit beds; for others, intensive care unit beds may be replaced by those in high dependency units. For a third group, however, it is essential that both extra intensive care unit beds and a high dependency facility are provided.