Too few ICU beds may up patient deaths

Friday, March 2, 2012

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By Amy Norton NEW YORK (Reuters Health) - A shortage of beds in hospital intensive care units may mean that more seriously ill patients die, according to a study from France.

Researchers focused on 10 hospitals in western France, where there's a known shortage of ICU beds.

They found that of 1,332 patients referred to the hospitals' ICUs over three months, almost 15 percent were turned away (at least temporarily) because there were no open beds.

And those patients had a higher risk of dying than patients who got into the ICU right away.

Overall, 33 percent died within the next 60 days, versus 27 percent of patients admitted to the ICU immediately.

The findings suggest that a shortage of ICU beds is leading to preventable deaths, the researchers report in the American Journal of Respiratory & Critical Care Medicine.

"Rationing" of ICU care is common, write the researchers, led by Dr. Rene Robert of Hospital Jean Bernard in Poitiers, France.

In some cases, patients are turned away because they are deemed not sick enough or, on the other hand, too critically ill to benefit from ICU care. But little had been known about whether lives are lost when an ICU simply has no beds open, Robert's team says.

Of the 193 patients in this study who were turned away from the ICU because of bed shortages, the majority were later admitted (sometimes because another patient was "bumped").

But 65 were never admitted. The solution to the problem is not "simple," according to Robert. One problem is that there's also a shortage of "regular" ward beds in some hospitals, he told Reuters Health in an email.

And even if ICU patients who were improving could be transferred to regular wards more quickly, that would not be enough to tackle the problem of ICU bed shortages, Robert said.

"There are discrepancies in the number of beds related to the population, at least in France, with dramatic differences from one area to another," Robert said. "I hope that the results of this study will help to convince authorities to re-analyze the ratio of ICU beds to population," he added.

Another issue is patient "triage" -- the process of prioritizing sick and injured people for treatment. French ICUs, Robert's team writes, tend to have "liberal admission policies," and there's "poor" compliance with triage guidelines.

So better triage may help, especially when ICUs are full, the researchers say. The extent of ICU bed shortages may vary from country to country, and within countries. In France, the number of ICU beds ranges from about 0.3 beds for every 10,000 people in some regions, to as high as 2.4 per 10,000 in other areas. The 10 hospitals in this study were at the lower end of that range. In the U.S., a recent study found that nationally, there are 2.8 ICU beds for every 10,000 people.

But it ranges anywhere from 1 to 6 beds per 10,000, depending on region. Whatever the extent of a country's ICU bed shortage, Robert said, the message of the current findings is the same: "If there is no ICU bed available for a critically ill patient, that induces an additional risk of death."

SOURCE: http://bit.ly/zk7aZS American Journal of Respiratory & Critical Care Medicine, online February 16, 2012.

Reuters Health