CRITICAL care bed capacity in Gwent needs to increase by 20 per cent in the next four or five years, to better meet current and future demand.
The Royal Gwent and Nevill Hall Hospitals currently have a combined total of 24 such beds – 14 intensive care and 12 high dependency.
But a critical care services delivery plan for Aneurin Bevan University Health Board states that there is a need for 30 under the proposed Specialist and Critical Care Centre model, which is currently scheduled to be fully operational by mid-2019.
The increase is necessary for a range of reasons, some of which are common to critical care provision across Wales.
Critical care units should run at an average occupancy of around 60-70 per cent, so emergency demand and bed occupation can be accommodated – but all units in Wales operate at over 80 per cent capacity, and some often at more than 100 per cent, meaning patients are occasionally cared for in other areas, such as operating theatre recovery rooms.
The situation also means that extra, unfunded critical care beds have to be opened on occasion, creating budget overspends.
The plan report also highlights an issue over delayed transfers of critical care patients who are deemed fit enough to be moved to other hospital beds.
These delays can contribute to the aforementioned problems with timely admission to critical care, and the target is that such transfers should take place within four hours of a patient being declared fit.
But most units in Wales fail to meet this target, and Gwent’s units underperform compared to these.
Delayed transfers from critical care can cause problems in other parts of the hospital system.
For instance operations may have to be cancelled if a critical care bed is available for a patient who may need one after surgery.
Reducing bed occupancy can also help reduce out-of-hours discharges to other parts of the hospital.
Research has shown that there are higher death and readmission rates for patients transferred from critical care between 10pm and 6am.
The health board’s critical care services delivery plan identifies work that is being done or planned, to improve critical care capacity during the next three years.
It includes outreach education teams to improve early recognition of deteriorating patients, blood poisoning screening for all acutely ill patients, and prioritising discharges from critical care.
The cost of increasing critical care capacity is not detailed, but is likely to be considerable, given that more medical and nursing staff will be needed, and a critical care bed can be more than four times more expensive to run than a general hospital bed.