Adult Critical Care Services

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Adult Critical Care Services

• An Irish Perspective

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Accessibility of Intensive Care Facilities in
Ireland to critically ill patients. Report of
ICSI Working Party Dublin (2001)

• 28 day clinical audit of ICU bed utilization in 9
  University Teaching Hospitals.
• ICU occupancy averaged 97 in the adult ERHA
  hospitals, 95 in the paediatric ERHA hospitals,
  and 98 in the non-ERHA hospitals
• Emergency referrals could not be accepted in
  greater than 30 of ERHA referrals
• Elective major surgery deferral was common across
  all hospitals surveyed
• Premature unplanned discharging of patients was
  practiced across all hospitals surveyed ( 22.6
  adult ERHA, 10.8 paediatric ERHA, 23.6
  non-ERHA).

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• Conclusions
• Critically ill adults and children are routinely
  denied timely
• intensive care services in Ireland. Cancellation
  of major
• surgery and premature discharge are routine.
  These
• practices are known to increase patient
  mortality.

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Eastern Region Critical Care Review 2004
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Bed requirement 2001 at standstill 100
occupancy 35 new ICU beds Since May
2004 SVH potential for 16 ICU Beds (but HDU a
peri-op ward)
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• Lyons et al for multi-centre ICU/HDU creates a
  figure of 51/500,000 ICU beds (10.2 per 100,000)
  and 87/500,000 HDU beds (17.4 per 100,000).
• For the ERHA, this works out as 142 ICU beds and
  243 HDU beds for population of 1.4 million. See
  page 13 of this review.

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Health Service Executive National Service Plan
2007
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National Perspective
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Preliminary Survey of Adult Critical Care
Capacity, Activity and Medical Staffing in
IrelandS Ó Riain, M Power on behalf of the
Intensive Care Society of Ireland

• Total ICU admission numbers from 35 of the 39
  hospitals for 2003 were
• 17,575.
• Only 86 consultants had any fixed in-hours
  sessions, designated or by
• arrangement, in ICU, out of 184 consultants
  providing an out-of-hours on-call
• service.
• Irish Journal of Medical Science 2005

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What happens to those 17,000 pts?

• No national dataset
• No national collaborative audit
• HIPE capture unreliable for CCM
• HIPE dataset unable to separate out CCU from CCM
  (ICU HDU)
• Local audit generally voluntary and not resourced

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Irish Critical Care Trials GroupDemographic
Study 2006
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Total1029
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Top 10 reasons for admission to ICU
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Top 10 reasons for admission to ICU from AE
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Top 10 reasons for admission to ICU from Ward
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System Pressure
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Audit of Mobile Intensive Care Ambulance Service
in Ireland. D Rohan, R Dwyer, J Costello, D
Phelan.

• MICAS activity by year (1996- 2004)

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HSE Population 1981-2006
According to the 2006 census there are 4,234,925
people living in the Republic of Ireland,
compared with 3,917,203 in 2002. This represents
an increase of 8.1.
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Population Projections 2005-2019
With the exception of the CSO low data, all the
other projections seem to be following a similar
growth pattern, with the population estimated to
reach five million by 2019
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ICM Reports

• Accessibility Report 2002
• Eastern Region Critical Care Review 2004
• MICAS Report 2005
• Planning and Development Report 2006
• ICSI Demographic Study 2006
• Bed Capacity Review (PA Consulting) 2007

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Intensive Care Specialist Staffing Recommendations
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AustraliaReview IC-2 (2000)For the
daytime, ward round based component of practice,
the maximum number of patients managed by a
single specialist should not exceed 12 to 16

• Victoria 1 FTE 4.09 ICU beds
• Australia 1 FTE 4.62 ICU beds
• Victoria 1.22 FTE 100,000 pop.
• Australia 1.39 FTE 100,000 pop
• Ireland 206 public ICU beds
• ? 50 FTE required for ICU alone (not HDU)

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COMHAIRLE na nOSPIDEAL

• QUALIFICATIONS
• Anaesthesia
• Emergency Medicine
• Medicine
• Intensive Care

• 1. CONSULTANT IN INTENSIVE CARE MEDICINE
• 2. CONSULTANT ANAESTHETIST WITH
• SPECIAL INTEREST IN INTENSIVE CARE MEDICINE

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ICM Training Graduation

• gt 100 DIBICM graduates to date since 1996
• EDIC 2 numbers from Ireland quite small
• However
• Many in-post already
• All dual qualified
• 98 from Anaesthesia base specialty
• Access to modular one year posts very limited
• Training within SpR programme of parent specialty

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0.45 WTE / Bed?

• Aim to align with international best practice
• ICM training posts accredited and standalone
• ICM needs to be attractive as a specialty
• Better resourced
• Appropriate bed capacity
• Appropriate occupancy rates
• Increasing emphasis on role of acute medicine
• ICM needs to be a Specialty

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