NHS bed shortages see patients kicked out of intensive care
DOZENS of patients have been moved out of critical care units before they are ready because hospital bosses are short of staff and beds.
Around 140 people treated for serious conditions were discharged from intensive care or high-dependency units in the Lothians last year because of a lack of capacity and manpower.
In total, just over 7000 patients were discharged from critical care units at the ERI, Western General and St John’s in Livingston, with one in 50 being moved on “early” – meaning the transfer was not in their best interest medically but was necessary because of pressure on beds or staffing.
Patients’ groups today warned doctors were being put under pressure to release patients before they were well enough.
Dr Jean Turner, director of the Scotland Patients Association, said medics in critical care wards often faced “terrible dilemmas” and called for urgent action to address staffing and capacity issues.
She added: “It’s terrible that health professionals have to make decisions to move people who would be better where they are because there’s someone else who has an even more horrendous problem.
“It could lead to someone’s early demise when they could have been well treated.”
In one unit – a joint intensive care and critical care ward at the ERI – doctors discharged five per cent of patients because of staffing or bed concerns.
At the Western General’s neurological units, between four and five per cent of discharges were categorised as “early” in the Scottish Intensive Care Society’s audit.
At St John’s, three per cent of critical care patients were moved before they were medically ready. Two per cent of patients in the ERI’s transplant ward were discharged before they should have been, while one per cent of patients in the hospital’s stand-alone high-dependency ward, renal high-dependency ward and vascular units left early.
MSP Jackson Carlaw, health spokesperson for the Scottish Conservatives, said no patient should be discharged before they were ready and that staff were being put in a “hugely unfair” position by being forced to decide who would be harmed least by being moved.
He added: “It has been apparent for some time that patients may be being discharged early. But what we have now is emerging evidence of how established this has become, and to see it being justified to deal with issues of capacity will set alarm bells ringing.
“The SNP has repeatedly vowed that, amid the financial cutbacks it is making to the NHS, front-line services will not be affected. Evidence produced in this report suggests otherwise.”
A British Medical Association Scotland spokesman said: “Because of the urgent nature of the care provided in these units it is vital that there is capacity to meet demand.
“However, this should not be at the expense of moving patients out when they still require specialist care. It is essential that NHS boards plan services around demand so patients are the priority, not victims of budgetary pressures.”
The number of sick patients being forced out of critical care wards too quickly is on the rise in the Lothians, from 123 in 2010 to the 140 in 2011.
Dr David Farquharson, medical director for NHS Lothian, said: “Of 7025 patients discharged from critical care units, a small percentage of patients discharged were classed as ‘early’.
“This often means that a recovering patient was moved to allow space for an emergency admission. It does not mean that all patients who were discharged early were moved to an inappropriate area.
“It is not possible to have an empty bed for 100 per cent of episodes of demand and the critical care capacity in NHS Lothian is used flexibly for optimal patient care and efficiency.”
Held up by lack of beds
On other occasions in 2011, patients who were well enough to leave critical care wards were not able to do so, often because beds in more appropriate areas were full up.
At the Edinburgh Royal Infirmary’s high-dependency unit, 49.8 per cent of 1310 discharged patients had to wait six hours or longer to be moved – the highest rate in all hospitals in Scotland.
At the Western General Hospital’s surgical high-dependency unit, 38.4 per cent of discharges were delayed – the third highest rate in the country.
NHS Lothian has previously admitted its core capacity is insufficient across the whole health board.
Dr David Farquharson, NHS Lothian’s medical director, said: “When some patients are ready to leave critical care, they may have to wait for a bed on the most appropriate ward for them, which can often be a speciality service. Ward capacity is under regular review and we are working to improve delays.”
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