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Health economist John Appleby
"In the end the NHS must respond"
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Friday, 14 July, 2000, 08:37 GMT 09:37 UK
Poor intensive care 'risking lives'
intensive care bed
The government has pledged extra intensive care funds
A study has revealed that more patients died in the intensive care unit of a Scottish hospital when the workload on staff increased.

A study carried out by doctors in Dundee suggests that poor levels of intensive care are putting patients needlessly at risk.


The quality of care in the Ninewells ICU is comparable to similar centres in the country

Spokesman for Ninewells Hospital, Dundee

They found that patients had a higher risk of dying if they were admitted to an intensive care unit that was understaffed or over-stretched.

The doctors examined death rates among critically ill patients at Ninewells Hospital in Dundee, between 1992 and 1995.

Using a special mathematical equation, they calculated that 288 patients would have been expected to die while receiving intensive care treatment over the course of the four years.

'Overstretched'

However, figures from the hospital showed that the actual number of deaths was 337, some 16% higher than expected.

They found that patients were twice as likely to die when the intensive care unit was overstretched compared to those who were admitted when workload was low.

"We found that patients exposed to high ICU workload were more likely to die than those exposed to lower workload," they said.

"If nursing requirement exceeds the provision of appropriately trained staff, or if the number of beds occupied exceeds the number appropriately staff, nursing and medical effort will be thinly spread."

They said patients may be exposed to greater risks from the effects of "excessive workload".

This included:

  • Insufficient time for clinical procedures to be done appropriately
  • Inadequate training or supervision
  • Errors
  • Overcrowding
  • Hospital-acquired infection
  • Limited availability of equipment or premature discharge from the ICU.

Writing in the latest issue of The Lancet, the doctors called for a study into reducing the number of inappropriate admissions.

A spokeswoman for Ninewells Hospital said: "The paper in The Lancet is only suggestive that there is an increase in mortality in the Ninewells Intensive Care Unit when workload rises.

"A national audit of Scottish ICUs suggests that the quality of care in the Ninewells ICU is comparable to similar centres in the country."

She said that staff and bed numbers in the ICU had increased since 1995 which have eased pressure at the hospital.

The government announced in May it would allocate 150m off the 600m announced in the Budget to pay for an extra 220 critical care beds.

It was an attempt to reduce some of the strain on the health service caused by winter pressures such as flu outbreaks.

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See also:

22 May 00 | Health
Millions for critical care beds
19 May 00 | Health
Emergency care 'getting better'
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