Journal of the Intensive Care Society

To examine the extent of critical care activity, on each weekday, in 9 hospitals accepting acute medical and surgical patients.

Census of 17339 patients in Lancashire and South Cumbria.

All acute medical and surgical wards in these hospitals.

Census conducted by the local service improvement leads for critical care.

A programme of dates was agreed on which to collect the data, in February and March 2004, for each day of the week including Saturday and Sunday. On each of these days the service improvement leads visited each ward in their acute hospitals and counted patients at different levels of need using the Intensive Care Society's Definitions of levels of critical care for Adult Patients (published in their standards and guidelines document). The locations of these patients were noted, in addition to the specific criteria which defined the individual level. Data was entered into a database for analysis and then returned to individual trusts' critical care delivery groups for discussion. Hospitals were also contacted to define their numbers of beds allocated for intensive care and high dependency care.

19.49% (3380) of patients were defined as Level 1, 3.45% (598) of patients were level 2 and 0.99 % (171) were Level 3.

Clinical activity at all levels was evenly distributed throughout the week and weekend. Demand for Level 2 support outstrips the supply of beds in higher care areas such as ITU and HDU. Many of these patients are managed on general wards, whereas beds defined as ITU beds outstrip Level 3 demand. Critical care services should focus on increasing flexibility of critical care bed use rather than predefining beds as for either ITU or HDU.