Intensive care specialists say the Ministry of Health is vastly overestimating ICU capacity and figures obtained by Newsroom appear to back them up, Marc Daalder reports
As of 9.05am on Tuesday morning, there were 152 staffed intensive care beds across New Zealand (excluding Christchurch). All but four of them were full.
That's according to a snapshot obtained by Newsroom of the Critical Health Resource Information System (CHRIS), which updates ICU capacity twice a day with submissions from each of the country's public hospitals. It's also much, much lower than the estimates provided by the Ministry of Health, which told Newsroom on Monday there were 297 staffed ICU beds in the public health system.
A spokesperson for the Australian and New Zealand Intensive Care Society (ANZICS) said the CHRIS figures are more accurate than the ministry's, which they say include paediatric beds that cannot treat adults, private beds not available for the Covid-19 response and beds that don't have nurses to staff them.
"The Critical Health Resources Information System (CHRIS) database contains information on almost every New Zealand public ICU updated at least daily by clinicians working in those ICUs. As such, it represents close to real-time data reflecting current ICU capacity," the spokesperson said.
"The quoted '297 staffed beds' is made up of physical beds (both staffed and unstaffed) in New Zealand's public hospitals, five private hospital ICUs, and the paediatric ICU in Starship Hospital in Auckland. This total also conflates both High Dependency (HDU) and Intensive Care (ICU) capacity. HDU beds cannot be used for a patient requiring ventilation (life support). Current capacity is determined by actual staffed, not physical beds. Beds without staff attached cannot have patients admitted into them."
Jess Smaling, the Ministry of Health's associate deputy director-general and group manager for DHB planning, conceded that the ministry's figures include HDU beds.
"Critical care covers a range of illness severity from patients just needing some more intense short-term monitoring, such as post-surgery, through to patients with multiple issues who require 1:1 care sometimes for long periods. Across this spectrum of Intensive Care (ICU), High Dependency (HDU) and Paediatric Intensive care beds (PICU), the DHBs report daily around 295 beds," she said.
"The CHRIS system only currently includes ICU beds in terms of resourced beds and in addition does not include a number of DHBs, including Canterbury. Most large critical care units run a mixed ICU/HDU model, where resourcing is balanced against the care needs of the patients. This means there can be daily changes in the number of beds able to be resourced."
The CHRIS figures also align more closely with an estimate of ICU capacity in October 2021, published in the New Zealand Medical Journal. That study found there were 176 staffed ICU beds in the public health system, 15 of which were paediatric. It also excluded HDU beds.
The figures supplied to Newsroom exclude Christchurch and a number of smaller hospitals which have no ICU beds at all. It is understood that Christchurch could be expected to add about 20 staffed beds to the country's capacity, but that most of these are also full. They also exclude most private hospitals.
Experts have previously criticised the Ministry of Health's health system preparedness, saying it counts beds that can't be staffed as available for use. Newsroom double checked with the ministry that its figure of 297 ICU beds was meant to include only staffed beds in the public health system.
"Each staffed ICU bed generally requires between five and six trained specialist ICU nurses to provide 24/7 care for a critically ill patient," the ANZICS spokesperson said. The Ministry of Health's figures suggest there are around 1500 trained ICU nurses staffing beds across the country. The ministry also told Newsroom that only 184 ICU beds were occupied, indicating that more than 100 beds (or 500 nurses) are idle.
The intensive care society said this made no sense, as there would be no need to defer planned surgeries if more than 100 beds were staffed and available for post-operation recovery.
"The information available to ANZICS through CHRIS is that, during the current pandemic, there have never been 100 spare staffed ICU beds in New Zealand. If there were, given the considerable cost of staffing an empty bed, this would represent significant inefficiency," the spokesperson said.
"Prior to the pandemic, New Zealand ICUs deferred elective surgery 12-15 percent of the time, compared to Australia (with almost twice the ICU capacity) at 2 percent of the time. This reflects more accurately the ongoing lack of ICU capacity, outside of pandemic times."
The crunch is even worse right now, with many ICU nurses and doctors isolating at home with Omicron.
"According to CHRIS, ICU staffing is being impacted nationally, along with every other hospital ward or department. Whilst additional FTE has been approved for ICU nursing positions there is no sign nationally that the net position has improved" since the October 2021 survey was conducted, the ANZICS spokesperson said.
If current caseloads in ICU were sustained over the coming weeks or months, the spokesperson said further disruptions to planned care would be needed. While Omicron wasn't expected to overwhelm ICUs like Delta did overseas, the worst case scenario would see newly-trained nurses taking on critical care work.
"Should additional ICU capacity be required, many ICUs have plans in place to enable this. However it would involve dilution of our usual model of care, where nurses from outside ICU would be looking after critically ill patients. Overseas experience has shown that reducing our best model of care is likely to mean we may not continue to achieve the best outcomes for critically ill patients."
