Other patients are faced with an unplanned discharge from the intensive care unit in the middle of the night before they are ready, because someone needs to be admitted with a more pressing emergency.
The insight into how hospitals are struggling to find space to properly care for the sickest patients has emerged in the Irish National Intensive Care Unit's 2022 annual report from the National Office of Clinical Audit.
It found that patients in Ireland are sicker by the time they enter intensive care, compared to Britain; the average score for disease severity was 16 in Ireland, compared to 14.5 in Britain.
It shows that the average number of intensive care and high dependency unit beds opened daily in publicly funded hospitals in 2022 – when the impact of Covid was still significant – was 289, equivalent to 5.6 intensive care beds care per 100,000 inhabitants.
This is low compared to international standards: Britain has 7.3 beds and the OECD average is around 12 beds per 100,000 inhabitants.
Nationally, 9% of patients admitted from a ward developed multi-organ failure within 24 hours of admission to intensive care, more than the 6% in Britain.
“This indicates delays in intensive care admissions, likely due to a shortage of beds, highlighting the need for timely intervention for critically ill patients,” the report said.
Beaumont Hospital, Mater Hospital, St Vincent's Hospital, Cork University Hospital and Tipperary Hospital all fell short of the acceptable limits in this benchmark.
Patients who develop multi-organ failure are at greater risk and face prolonged intensive care stays, and potentially long-term health consequences.
While 85% of patients were placed in intensive care within four hours of the decision to be admitted, only 30% were there within an hour, although the target is 50%.
A lack of beds in hospital general wards meant that 27% of patients spent more than 24 hours in intensive care after being discharged, compared to 20% in 2021 and 6% of bed days were occupied by patients who were not there should have been longer. Some patients who would be treated in intensive care in Britain are being cared for in wards here.
However, the report said that despite the pressure, the national mortality rate for intensive care patients was, as expected, 24 percent, taking into account factors such as how sick the patients were.
It said 76% of patients admitted to intensive care survived to leave the acute hospital alive.
The report, which looked at 11,008 admissions of 10,423 patients in 26 units in 22 hospitals, found that the average bed occupancy rate nationally was 92%, but in many of the larger units it was more than 95%.
“This high occupancy rate leads to periods when intensive care beds are all occupied and unavailable for urgent admissions,” the report said.
A third of the patients were admitted from the emergency department, 20% from another department, 10% from another hospital and 16% after surgery.
Common reasons for illnesses included sepsis, respiratory problems, accidents, cardiac arrest and undergoing surgery. Patients admitted with Covid had longer stays, making up 6% of all admissions and occupying 12% of all bed days.
Among intensive care patients in 2022, 144 were pregnant or recently pregnant, some of whom contracted Covid.
There was evidence that patients with sepsis were not diagnosed early enough at Beaumont Hospital, Cork University Hospital, Tallaght Hospital and Tipperary Hospital.
The report identifies a 28 percent increase in the number of intensive care beds since March 2020 as a significant achievement.
A national policy of keeping one staffed intensive care bed empty for immediate admissions is critical to ensuring that critically ill patients can access beds without delay. Adequate staffing is also essential.
Prof. Rory Dwyer, clinical lead for Ireland's national critical care audit, said: “The report highlights both our performance and the areas that need attention in critical care. It is clear that while the quality of care remains high, the pressure on our intensive care resources is significant. Expanding capacity and ensuring timely admissions and discharges are critical to improving patient outcomes.”
In response, the HSE said that an investment of €77 million in 2021 and 2022 has increased the number of intensive care beds from 258 in March 2020 to 329 by the end of December 2023. A further 22 additional intensive care beds are planned in 2024 and upon completion, the total number of funded intensive care beds will increase to 352 by the end of the year, a spokeswoman said.