Seriously ill refused beds

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The Independent Online
Health ministers last night ordered an urgent review of intensive care provision after a government study revealed that one in four patients referred to a unit were turned away.

Some of the rejected patients had a 50 per cent higher chance of dying than some of those who got a bed, the study found.

The most common reason for refusal was because beds were full; there was a shortage of nursing staff; the patients were "too well" for intensive care nursing or were terminally-ill and would not survive anyway.

The report also highlights a "disturbing" lack of consultant involvement in ICUs. Almost three-quarters of the 169 units in the survey did not have a full-time [consultant] director. Nearly half of the units did not have a consultant present at any time during the "census" day when activity on the unit was recorded.

The long-awaited study was published the day after another survey by consultants at St George's Hospital, London, revealed that almost 20 per cent of ICU beds in major cities had been closed due to lack of money or specialist nurses.

The lack of High Dependency Units (HDU) in hospitals is also criticised. These units provide an intermediate level of care between intensive nursing and that on a general ward. Only 34 of the acute hospitals in England had an HDU at the time of the survey in May 1993.

Tom Sackville, a junior minister at the Department of Health, limited his comments to the study's finding that one in six referrals to intensive care were "inappropriate". He urged health authorities to review their intensive care needs.

"It is no good hospitals establishing larger intensive care facilities to satisfy peaks of demand. Highly-staffed beds then lie empty the rest of the year," Mr Sackville said.

But one leading consultant said that intensive care had been "under-valued, under-funded and under-staffed for decades". Dr David Bennett, director of intensive care at St George's Hospital accused the Government of a panic response by rushing out its own study.

"Whether or not we would have had any statement at all from the Government if our [the St George's study] had not prompted it, is debatable," he said. He agreed that some referrals were inappropriate, but argued there was nowhere else for these patients to go.

The study involved a postal questionnaire and a three-month follow-up of patients admitted or refused admittance to six ICUs in England.

Alison Metcalfe, a research fellow at the London School of Hygiene and Tropical Medicine, one of the authors of the report, said the findings were highly complex, but ". . . using all the information available to us, there does seem to be a higher risk of dying for this refused group when compared with . . . the admitted group".

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