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

Lookup NU author(s): Dr David Saunders

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Abstract

© 2019 British Journal of Anaesthesia 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.

Publication metadata

Author(s): Wong DJN, Popham S, Wilson AM, Barneto LM, Lindsay HA, Farmer L, Saunders D, Wallace S, Campbell D, Myles PS, Harris SK, Moonesinghe SR

Publication type: Article

Publication status: Published

Journal: British Journal of Anaesthesia

Year: 2019

Volume: 45

Issue: 1

Pages: 181-193

Print publication date: 01/03/2020

Online publication date: 24/08/2019

Acceptance date: 08/07/2019

ISSN (print): 0007-0912

ISSN (electronic): 1471-6771

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.bja.2018.12.026

DOI: 10.1016/j.bja.2018.12.026

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