Busy ICU spilling patients

Chronically ill patients are being "routinely" turned away from Christchurch Hospital's intensive care unit (ICU) due to a lack of resources.

The unit's inadequate resourcing has led to the cancellation of elective surgery and the transfer of high-dependency patients to other hospitals around the country, its clinical director said.

Christchurch's ICU is the biggest in the South Island, yet it has only 17 beds, which are full almost 85 per cent of the time, an occupancy rate higher than the national 60 per cent average.

Patients that would benefit from ICU care are "routinely declined admission" and are left in a "suboptimal environment resulting in increased risk", says a report provided to the Canterbury District Health Board (CDHB) by ICU clinical director Seton Henderson.

The report says the unit's available beds have increased from 12 to 17 over the past four years, but "demand continues to exceed supply".

In the report, Henderson puts forward a bid to temporarily expand ICU into the recently abandoned former Cardiothoracic Ward adjacent to it.

He asked for funding approval from the CDHB to increase ICU by five beds until the hospital redevelopment was completed. Current estimates put this at 2018.

The temporary expansion would result in reduced risk of "major complications and death".

"To do nothing is not acceptable as managing demand for ICU level care will become increasingly more of a challenge and ICU capacity will be a constraint to maintaining the current volume of elective surgery," the report said.

A lack of resources caused the cancellation of elective surgery cases that required post-operation ICU care.

In 2011/12, there were 12 cardiac surgeries cancelled and in 2012/13 there were 31 cancellations.

"Every effort is made to provide intensive care therapy for all critically ill patients, however, unlike other inpatient services, there is no intensive care overflow capacity within Christchurch Hospital or the Canterbury region," the report said.

The ICU provides intensive care services to the 542,540 Kiwis who live in Canterbury and on the West Coast and it also provides specialised services for patients across the South Island and lower North Island.

Increasing capacity would allow critically-ill children to access the specialised ward for the best care possible and it would ease pressure from the impending hospital repair work, which is expected to close three of the unit's beds for several weeks.

ICU head Geoff Shaw said the unit's lack of resources was historical and that Christchurch's clinical teams had developed a culture of coping.

An intensive care outreach service assists medical and nursing staff in wards to provide care to high-dependency patients who did not require ventilation.

The outreach service provides care to about 3600 patients each year.

"The question is are those patients better served in an expanded ICU, or are they better looked after in their own wards with specialist input?" Shaw said.

The Press understands the new hospital's ICU is expected to have 36 beds - 28 adult beds and eight paediatric beds.

The Press