Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand

Danny Jon Nian Wong, Scott Popham, Andrew Marshall Wilson, Lisa M. Barneto, Helen A. Lindsay, Laura Farmer, David Saunders, Sophie Wallace, Douglas Campbell, Paul S. Myles, Steve Kendrick Harris, Suneetha Ramani Moonesinghe, the SNAP-2: EPICCS collaborators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity’ beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions: Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.

Original languageEnglish
Pages (from-to)460-469
Number of pages10
JournalBritish Journal of Anaesthesia
Volume122
Issue number4
DOIs
Publication statusPublished - Apr 2019

Keywords

  • critical care
  • health services research
  • patient safety
  • perioperative care
  • postoperative complications

Cite this

Wong, D. J. N., Popham, S., Wilson, A. M., Barneto, L. M., Lindsay, H. A., Farmer, L., ... the SNAP-2: EPICCS collaborators (2019). Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand. British Journal of Anaesthesia, 122(4), 460-469. https://doi.org/10.1016/j.bja.2018.12.026
Wong, Danny Jon Nian ; Popham, Scott ; Wilson, Andrew Marshall ; Barneto, Lisa M. ; Lindsay, Helen A. ; Farmer, Laura ; Saunders, David ; Wallace, Sophie ; Campbell, Douglas ; Myles, Paul S. ; Harris, Steve Kendrick ; Moonesinghe, Suneetha Ramani ; the SNAP-2: EPICCS collaborators. / Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand. In: British Journal of Anaesthesia. 2019 ; Vol. 122, No. 4. pp. 460-469.
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abstract = "Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity’ beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7{\%}), 35 Australian (response rate: 32.7{\%}), and 17 NZ (response rate: 94.4{\%}) hospitals (total 309). Of these hospitals, 91.6{\%} reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1{\%} of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions: Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.",
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Wong, DJN, Popham, S, Wilson, AM, Barneto, LM, Lindsay, HA, Farmer, L, Saunders, D, Wallace, S, Campbell, D, Myles, PS, Harris, SK, Moonesinghe, SR & the SNAP-2: EPICCS collaborators 2019, 'Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand' British Journal of Anaesthesia, vol. 122, no. 4, pp. 460-469. https://doi.org/10.1016/j.bja.2018.12.026

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand. / Wong, Danny Jon Nian; Popham, Scott; Wilson, Andrew Marshall; Barneto, Lisa M.; Lindsay, Helen A.; Farmer, Laura; Saunders, David; Wallace, Sophie; Campbell, Douglas; Myles, Paul S.; Harris, Steve Kendrick; Moonesinghe, Suneetha Ramani; the SNAP-2: EPICCS collaborators.

In: British Journal of Anaesthesia, Vol. 122, No. 4, 04.2019, p. 460-469.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Wong, Danny Jon Nian

AU - Popham, Scott

AU - Wilson, Andrew Marshall

AU - Barneto, Lisa M.

AU - Lindsay, Helen A.

AU - Farmer, Laura

AU - Saunders, David

AU - Wallace, Sophie

AU - Campbell, Douglas

AU - Myles, Paul S.

AU - Harris, Steve Kendrick

AU - Moonesinghe, Suneetha Ramani

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N2 - Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity’ beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions: Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.

AB - Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity’ beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions: Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.

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KW - health services research

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