Specialists warned authorities of intensive care crisis a year ago

INTENSIVE care specialists warned over a year ago of a crisis in services but they say little has been done since to address the issues raised.

The Intensive Care Society of Ireland (ICSI) published a survey in March last year which found up to one-third of critically ill patients referred to intensive care units (ICU) were refused admission because of a lack of beds and a severe shortage of ICU nurses.

The study was carried out at 10 of the country's largest hospitals, including Our Lady's Hospital for Sick Children, Crumlin, and found that while the situation was worst in the Eastern Region Health Authority (ERHA), it was also "intolerable" in the rest of the country.

Among the statements made by the authors on the findings of their report were the following:

Critically ill adults and children are routinely denied timely intensive care services in Ireland. Cancellation of major surgery is routine.

All the ICUs surveyed were utilised beyond what would be internationally regarded as a safe capacity.

The primary reason for the inability to provide critical care to referred paediatric patients was the unavailability of suitably trained nurses.

Most prophetic of all was the finding that the only two children's ICUs in the country at Crumlin and Temple Street Children's Hospital turned away 34% of all referrals, which would include those like baby Róisín Ruddle who was scheduled for elective surgery, and 30% of all emergency referrals, which would include children who had already undergone a surgical procedure.

In some cases, the reason for the refusal was the lack of a bed but the overwhelming factor, accounting for 74% of refusals, was the lack of specially trained ICU nurses.

The findings are most relevant to Crumlin as Temple Street's ICU deals mainly with paediatric kidney patients.

ICSI president Dr Brian Marsh said the issues raised by the survey were first brought to the Department of Health's attention in June 2001.

Once the survey was made public in March last year, the ERHA set up a review committee, of which Dr Marsh was a member, and while they had recently completed a draft report, he said yesterday there had been little in the way of a real breakthrough.

"The difficulty with the review process is that it lacks a certain urgency and there is urgency required, as we can see now, to make sure that ICU nursing is an attractive option."

Dr Marsh said there had been no organised response from hospitals or health boards outside the EHRA to last year's report.

Meanwhile, more than 400 hospital beds have been closed since the start of the year, a leading patient's rights group said yesterday.

The Irish Patients Association (IPA) said over half of these beds have been closed for financial reasons.

Chairman of the IPA, Stephen McMahon warned that the 418 closures might increase significantly in the next few months.