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Wednesday, October 27, 1999 Published at 14:19 GMT 15:19 UK


Intensive care 'failing patients'

Intensive care units save two out of every three patients

Many intensive care units in England and Wales are not saving lives because of clinical and administrative failures, a report has said.

BBC News Richard Hannaford: "Not all intensive care units providing the same standards of care"
The Audit Commission reveals that death rates in critical care units vary from one hospital to another. It calls for more flexible working patterns and research into which treatments save most lives.

Critical care experts have responded by calling for more resources. They warn that without new funds the government's pledge to improve care of cardiac and cancer patients will be very difficult to achieve.

However, the government says the problems are not caused by financial problems.

The Audit Commission report, "Critical to Success" examines the service provided by both intensive care (ICU) and high dependency units (HDU) in which seriously ill patients receive constant medical attention.

It finds:

  • Mortality rates varied between hospitals, even when allowing for differences in the type of patients admitted

  • Very little data was available about the effectiveness of the treatments carried out in critical care units

  • At peak times some patients cannot be admitted unless they are transferred to another hospital, while others may be discharged early

  • Poor ward care or unit management in other parts of a hospital can unnecessarily inflate the demand for critical care beds

  • Units with similar workloads vary by as much as 50% in the number of nurses they employ

  • The cost of consultants varies between similar-sized units by a factor of three

  • Follow up and rehabilitation of survivors is carried out in only a few hospitals

The Audit Commission researchers also found that between 1993 and 1998 the average number of beds in an ICU rose by 50% from four to six, and that costs are increasing at around 5 to 10% each year.

On average NHS staff save the lives of two in three ICU patients.

Andrew Foster, controller of the Audit Commission, said: "Staff in critical care units should be praised for providing a vital service in a very pressurised and traumatic environment.

"However, our report raises concerns that some hospitals are not making the best use of current resources."

He also called for more research into the reasons why some hospitals had higher mortality rates than others, saying "there are few ready explanations".

'Low budget'

The Audit Commission report was welcomed by the Intensive Care Society, which represents more than 1,400 doctors and nurses.

Dr Paul Lawler, a past president of the society, said the UK spent only 1% of its small health care budget on intensive care, compared with 10% in the US.

He said: "Organisational changes must go side-by-side with an increase in critical care facility.

"In the meantime, frequent transfer of patients between intensive care units will remain the norm rather than the exception."

But Health minister Gisela Stuart told the BBC's Today programme that the report showed the problems were not necessarily due to financial problems.

"What's quite clear is that there is no direct relation between the number of beds [and the death rate]," she said.

"It's how you use them. A lot of it depends on the internal [hospital] management."

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