Fewer ICU Beds Mean More Patient Deaths

A study from France has found that a shortage of beds in hospital intensive care units may mean that more patients die.

An article from Reuters reports on the study, which focused on 10 hospitals in western France. The researchers found that almost 15% of the 1,332 patients who had been referred to the hospitals’ ICUs over three months were turned away due to a lack of open beds.

The patients who were turned away had a higher risk of dying than patients who were accepted into the ICU; 33% of the patients who were turned away died within the next 60 days, while 27% of the patients who made it to the ICU of the hospital died within that time frame.

These findings address questions about how people fare when they are turned away from the ICU due to “rationing,” when patients are turned away because they are considered to not be sick enough or, conversely, so sick that medical care won’t help them. The study indicates that the shortage of ICU beds is leading to preventable deaths.

Of the 193 patients in this study who were turned away from the ICU because of bed shortages, the majority were later admitted (sometimes because another patient was “bumped”).

But 65 were never admitted. The solution to the problem is not “simple,” according to Robert. One problem is that there’s also a shortage of “regular” ward beds in some hospitals, he told Reuters Health in an email.

And even if ICU patients who were improving could be transferred to regular wards more quickly, that would not be enough to tackle the problem of ICU bed shortages, Robert said.

“There are discrepancies in the number of beds related to the population, at least in France, with dramatic differences from one area to another,” Robert said. “I hope that the results of this study will help to convince authorities to re-analyze the ratio of ICU beds to population,” he added.

Another issue is patient “triage” — the process of prioritizing sick and injured people for treatment. French ICUs, Robert’s team writes, tend to have “liberal admission policies,” and there’s “poor” compliance with triage guidelines.

So better triage may help, especially when ICUs are full, the researchers say. The extent of ICU bed shortages may vary from country to country, and within countries. In France, the number of ICU beds ranges from about 0.3 beds for every 10,000 people in some regions, to as high as 2.4 per 10,000 in other areas. The 10 hospitals in this study were at the lower end of that range. In the U.S., a recent study found that nationally, there are 2.8 ICU beds for every 10,000 people.

But it ranges anywhere from 1 to 6 beds per 10,000, depending on region. Whatever the extent of a country’s ICU bed shortage, Robert said, the message of the current findings is the same: “If there is no ICU bed available for a critically ill patient, that induces an additional risk of death.”