Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand

Abstract

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities.

Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively.

Conclusions: Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.

Keywords: critical care; health services research; patient safety; perioperative care; postoperative complications.

Fig 1

Scatter plot of critical care beds vs. hospital size, with hospitals coloured by tertiary status. A line of best fit as estimated using a negative binomial regression model illustrates the higher number of critical care beds in hospitals offering tertiary services, compared to hospitals not offering tertiary services.

Fig 2

Forest plot of associations between specialist services delivered and the relative availability of critical care beds per 100 hospital beds, after adjusting for hospital size, presence of enhance ward areas, presence of emergency department and country. ECMO = extra-corporeal membrane oxygenation; GI = gastrointestinal.