Bed numbers

Intensive care bed provision varies widely between countries, but this is partly due to differing interpretations of the term 'intensive care'. Some countries make a distinction between high-dependency care and intensive care, whereas others label all such areas 'intensive care'. In the United States and Scandinavia the provision of intensive care beds may account for up to 10 to 15 per cent of total acute hospital beds, whilst in the United Kingdom the provision has historically been less than 1 per cent. However, this may slowly be changing.

The ideal bed complement of a single ICU is a quite separate issue from the total number of ICU beds required for a population, but there is no international consensus on bed numbers or optimum ICU size. However, there is a clear view within the United Kingdom that 1 per cent of total acute beds represents serious underprovision for intensive care. In some hospitals it has been appropriate to form multiple small units specializing in, for example, neurosurgery, cardiothoracic surgery, burns, or pediatrics, while in other hospitals large multidisciplinary units are favored. To date there is little hard data on which model provides better care, but there appear to be economies of scale and greater nursing flexibility within larger units.

Units containing over ten beds demand full-time specialist medical cover, but this is something which has traditionally not been the case in ICUs in the United Kingdom. In 1994 only a minority of ICUs had a full-time director and the median size was four beds. Perhaps these two findings are linked in that it is clearly not cost effective to provide a full-time director to look after four beds.

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