`Wrong patients put in high care units'

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Health Editor

Up to 50 per cent of patients in intensive care units do not need such a high level of care and could be treated on other wards to free urgently needed beds, senior doctors said yesterday.

They warned that the current shortage of beds meant that about 7 per cent of patients who need intensive care (IC) were being looked after on general wards, which could compromise their safety, while scores of operations were cancelled at the last minute as IC beds intended for post-operative patients were taken up by emergency admissions.

In addition up to 20 per cent of patients in acute surgical beds on general wards would do as well in "patient hotels", now being provided by small number of hospitals around the country.

The Royal College of Surgeons and the Royal College of Anaesthetists are calling for a review of how patients are cared for after surgery, with the introduction of "graduated patient care" which, the colleges say, would save the NHS hundreds of thousands of pounds.

A joint working party which studied eight hospitals concluded that this model was the most cost-effective and efficient use of resources.

Graduated patient care identifies patients who need IC with at least one nurse for every patient; those who would benefit from care in high dependency units (HDU), an intermediate level of care; and patients who are suitable for general surgical wards, and a convalescent or hotel unit for clinically stable patients able to look after themselves.

Stephen Dorrell, the Secretary of State for Health, last week gave his backing to an expansion of HDUs to alleviate the crisis in intensive care which has seen desperately ill patients shuttled around hospitals. In 1995 the National Confidential Enquiry into Perioperative Deaths highlighted the lack of HDUs nationally.

David Crosby, a consultant surgeon and member of the Royal College of Surgeons' working party which reviewed care levels, said: "This is long- overdue. We have a situation in 1996 in which 85 per cent of large, acute, NHS hospitals have only two levels of post-operative care [IC and general] when there should be three."

The daily cost of an IC bed to the NHS is between pounds 1,200-pounds 1,500; an HDU bed pounds 400-500; and a bed on a general surgical ward between pounds 200-pounds 250.

t Report of the Joint Working Party on Graduated Patient Care; pounds 5; RCS on 0171 973 2147.