Covid-19: ICU specialists welcome additional beds but say more needed

Hospitals around New Zealand are routinely postponing up to 12 per cent of elective surgeries that need post-operative intensive care, even with no widespread transmission of Covid-19, an intensive care specialist says.

Craig Carr, an intensivist at Dunedin Hospital and the New Zealand regional chair for the Australia and New Zealand Intensive Care Society (ANZICS), said the ICU community did “not believe that New Zealand currently has sufficient ICU beds meet our population’s needs”.

His comments came despite Minister of Health Andrew Little’s announcement of $645 million in additional funding ($100m for capital works and $545m for operational costs such as staffing) approved by Cabinet to boost ICU capacity in the next six months.

Three district health board (DHB) proposals to boost the number of ICU beds at four hospitals were given the green light on Thursday– Waitemata, Canterbury and Tauranga – and the minister indicated more funding for other projects would be announced soon.

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Nationally, there are 284 resourced ICU and high dependency unit (HDU) beds in public hospitals, a number that can be increased to about 550 beds if there was a “major outbreak of Covid-19”, according to the Ministry of Health.

Andrew Stapleton, ICU specialist at Hutt Hospital and chair of the College of Intensive Care Medicine, said the ministry’s estimate of beds included 40 paediatric beds and cots, and did not include staffing.

The society estimated there were 174 staffed ICU beds for adults.

He said New Zealand had four ICU beds per 100,000, the least of all OECD countries. Australia had nine beds per 100,000.

Wellington Hospital ICU Expansion project won the health category in the New Zealand Commercial Project Awards 2019.

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Wellington Hospital ICU Expansion project won the health category in the New Zealand Commercial Project Awards 2019.

The minister’s announcement of funding for an additional 20 ICU beds across the three DHBs would take the rate to 5.2 per 100,000, Stapleton said.

But he said the additional funding was “really big”, and the only time-specific additional funding for ICU beds that has been given in 70 years.

Most critical was Cabinet approval for funding for additional staffing, Stapleton said.

Carr said data collected by ANZICS in 2019 showed New Zealand ICUs post-poned up to 14 per cent of surgeries requiring ICU such as “heart surgery, brain surgery, and even occasionally cancer surgery” due to a lack of resources.

Patients put on a waitlist would be at higher risk of deteriorating further, impeding their recovery when they do finally get surgery and even reducing their long-term life expectancy, Carr said.

Dr Craig Carr is the ICU clinical director for Southern DHB and the regional chair of the Australia New Zealand Intensive Care Society.

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Dr Craig Carr is the ICU clinical director for Southern DHB and the regional chair of the Australia New Zealand Intensive Care Society.

Despite the Little’s confidence about the country’s ICU capacity, Carr said he was not convinced this would stand when Covid-19 became endemic.

“I have not found evidence as to why we shall be significantly different from Scotland, Singapore, Ireland and other highly vaccinated countries when we reopen borders and endemic Covid spreads across New Zealand.”

This week he spoke to ICU specialists in Europe who reported increased ICU and hospital bed demand “as immunity wanes”.

“By my estimate, to meet similar demand to that seen overseas, we would require an approximate doubling of resourced ICU bed numbers from our current levels in New Zealand, which was why the announcement was welcomed.

“We should be actively seeking to resource additional beds and staff now and so an announcement of additional resource is very welcome.”

Increasing resource to meet demands required medium and long-term planning, as well as a short-term surge response as it took time to train new staff, recruit people with appropriate skills from overseas and upskill redeployed staff.

He noted many wards and specialities were experiencing staff shortages, not just ICU, and it would not help to “rob Peter to pay Paul”.

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